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Medical Forum / Diseases and Disorders / Prostate Cancer / December 2003

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Comments wanted on treatment

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olfart - 08 Dec 2003 13:57 GMT
I am 68 yrs old, reasonably good health and have just been diagnosed
with a small, cancerous prostate tumor. My PSA was 4.8 and the biopsy
found a small growth is just one of the 8 samples taken. The Doctor is
a Urologist and his feeling is that since it is small and was found
early that there should be no problem treating and eliminating the
cancerous cells. He proposes the following treatment:
Seed implantation plus external beam radiation plus hormone therapy.
I have an appointment with an Oncology Radiologist in a few days to
get his opinion.
Any comments would be welcome. Thanks
Leonard Evens - 08 Dec 2003 16:31 GMT
> I am 68 yrs old, reasonably good health and have just been diagnosed
> with a small, cancerous prostate tumor. My PSA was 4.8 and the biopsy
[quoted text clipped - 6 lines]
> get his opinion.
> Any comments would be welcome. Thanks

We are only lay people here, with a few exceptions, so we can only tell
you what we have learned from personal experience and reading.  The best
thing you can do now is learn as much as you can.   Make sure you
understand all the treatment possibilities available to you and the
advantages and disadvantages of each for cases similar to yours.  Also
make sure the doctor treating you is highly skilled and has a good track
record for such cases.

Many of us have found Patrick Walsh's Guide to Surviving Prostate Cancer
a good source of information, but some have criticized him for having a
surgeon's bias.  He certainly has some doubts about treatment by seeds
as compared to external radiation.   But if you keep his possible biases
in mind, his book is a good starting point.   Also look at
www.phoenix5.org as a source of information and other links.

Having said that, let me add that we need to know two other bits of
information to be able to make comparisons.   Did the urologist feel
anything on digital rectal examination and if so, was the cancer given a
stage designation?  Also, what was the Gleason score from the biopsy?

The therapy proposed in your case is one of several versions of
treatments by seeds.   The external radiation is supposed to supplement
the internal radiation by seeds and the hormones are sometimes
recommended short term in order to make the cancer more susceptible to
damage by radiation.   Long term hormone therapy would usually only be
recommended if it was felt that the cancer had already escaped to sites
distant from the prostate.

For comparison sake, I was diagnosed at age 67 with stage T1c (meaning
nothing unusual on digital rectal exam), PSA 4.5, and Gleason 7=3+4.  I
had cancer in four samples out of six on one side (12 samples total).
My urologist recommended either external radiation or surgery.   I chose
surgery because or a variety of reasons, one being that I would know
from the post surgical pathology report pretty well what my long term
prospects were.  I did pretty well.   The report showed cancer
restricted to the prostate.  I have had no evidence of spread since then
(over three years ago), I was continent within a month of the catheter
being removed, and I eventually gained a reasonable degree of potency.
 However, even during the 18 months when I was more or less totally
impotent, we managed an active sex life using a pump.  I suppose I was
fortunate in that I had a very good surgeon and my cancer was constrained.

Good luck, whatever you decide.
George Hays - 09 Dec 2003 14:22 GMT
> We are only lay people here, with a few exceptions, so we can only tell
> you what we have learned from personal experience and reading.  The best
[quoted text clipped - 39 lines]
>
> Good luck, whatever you decide.

Here is some info from my report
A. Prostate, right, biopsy. Carcinoma of Prostate. Gleason's score of
4+4=8, present in one of four prostate tissue cores. Approx 25% 0f the
coe and 10% of the total biopsy is involved.

B Prostate, left, biopsy. Benign prostate tissue.

Also there was nothing unusual found with digital exam.
PSA was 3.8 a year ago and is 4.8 now

Thanks for any comment on trreatment, side effects, results, etc
c palmer - 09 Dec 2003 21:48 GMT
hi george - i'll chime in with some things to think about.

here are some things on the table to look at.

good side - DRE didn't feel anything - 4.8 psa.

bad side - gleason 8.  more aggressive than the normal.  around here, it
seems a lot of 6's and 7's  

there is an order of progression on treatments,  surgery, radiation,
hormone therapy.  as you can tell if you have surgery, then if you had a
recurrance, you could do radiation.  if you do radiation, it would be
difficult to do surgery.  

each treatment has up sides and down side just as i have presented here.
research them very well.  there is no one answer.

another question -what is your health like?  
can you stand surgery whereas 5 years from that would not be an opinion.  

not trying to talk you into surgery, just pointing out that all these
factors are dynamic and can change.  

leaving the cancer to grow also changes the choice of treatments as
well.

that is why it is not a one size fits one answer.

research, and as you have questions, please post them.

hope this has helped.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional
George Hays - 09 Dec 2003 22:04 GMT
> hi george - i'll chime in with some things to think about.
>
[quoted text clipped - 31 lines]
>
> knowledge is power - growing old is mandatory - growing wise is optional

Thanks for the comments. Going tomorow to get a "second opinion" and
hopefullt more info on the options available. George
Leonard Evens - 09 Dec 2003 22:41 GMT
>>hi george - i'll chime in with some things to think about.
>>
[quoted text clipped - 53 lines]
> Thanks for the comments. Going tomorow to get a "second opinion" and
> hopefullt more info on the options available. George

You should get a second, possibly even a third, opinion on the pathology
of the biopsy samples.   As Curtis has pointed out,  Gleason 8  is
considered pretty high.  But T1c and PSA that low are good signs.  It is
possible the pathologist was wrong and another more expert pathologist
would come up with a lower Gleason score.  That could make a big
difference in deciding on a treatment plan.

Even if the Gleason score is confirmed, don't be too discouraged.  With
the other indications, there is still a reasonable chance of a complete
cure.
 
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