It has been a month since I signed in as a "Newly Diagnosed T1c".  I
want to thank everyone for the information and support.  

We have decided to use the Dana-Farber Cancer Institute after having
gone there for a second opinion.  We were very impressed with the
people and the facilities.  My wife and I spent the afternoon with a
Radiation Oncologist (Dr. Clair Beard), a Medical Oncologist (Dr.
Phillip Febbo), and a Surgical Oncologist (Dr. Jerome Richie).  Dr.
Richie was one of the surgeons I had already identified as being among
the best in the area (others included Douglas Dahl, Martin Sanda, and
John Libertino).  

They re-graded the biopsy slides from my first urologist at the New
England Medical Center.  There had been two positive sticks out of 14.
One had been graded Gleason 3+4=7 and the other Gleason 4+3=7 with
"perineural invasion not identified".   DFCI changed the 4+3 to a 3+4
but found some evidence of perineural invasion.  

Dr. Richie recommended against surgery for me.  He said that because
of the location of the cancer (the two apex samples) it would be
almost impossible to do a nerve sparing procedure and that conformal
three dimensional external beam treatment (3D XRT) combined with
hormone therapy had fully equivalent 10 year results and offered, in
my case, a better quality of life.

Interestingly enough, the urologist who had originally diagnosed my
cancer had recommended surgery.  I asked him if he could do a
nerve-sparing procedure and he said that he always went in with the
intension of sparing the nerves and was "successful most of the time".
In my case, I am sure that when I woke up he would have told me that
he had tried so very hard, but had been unable to spare the nerves.
So sorry.

I have since had an endo-rectal MRI and a bone scan and we will meet
with Dr. Beard in early February to plan my treatment program.  

Meanwhile, I will continue to research prostate cancer.  Just when I
think I have read everything that has been written about prostate
cancer I run across something new.  Most are redundant, and some are
way out, but occasionally one will provide something new and
interesting.  

David Hall
T1c
PSA 19
Gleason 3+4=7 on 2 sticks out of 14 with some evidence of perineural
invasion
64 years old