> Hi Leonard,
>
[quoted text clipped - 17 lines]
> I'm still at the research stage, but there is almost TOO much
> information. How to make a choice, should I need it, is beyond me.
I recommend reading Peter Scardino's "Prostate Book". Scardino is a
world renowned authority on prostate cancer. He is a surgeon, but he
works closely in his research with experts in all the relevant areas of
prostate cancer, so his book is a good starting point. It is well
written and keeps things as simple and straightforward as possible for
such a complex subject. I got it in paperback from Borders for about
$18, and most public libraries should have it. There is also Patrick
Walsh's "Guide to Surviving Proste cacer", which has a wealth of
information, but is a bit more polemical in places and sometimes less
clear. Walsh also, while a surgeon, works with many other experts. (I
emphasize that because sometimes you will be told not to pay attention
to urologists because they are surgeons and reject other approaches, but
that advice is highly misleading for both Scardino and Walsh.)
I am not a physician, so read anything I say, or for that matter
whatever else you find on the web, with more than a grain of salt.
Also, remember that what men tell you may be strongly influenced by
their experience. Each man is different, and prostate cancer varies
enormously. More so than for other diseases, there is not one single
approach which fits all men.
But I will try to tell you what I've gleaned from my reading and my
personal experience.
Most likely, you don't have prostate cancer. Remember that before
going on with what I say below.
If you do have prostate cancer, it very likely to be at a pretty early
stage. Before choosing a treatment, you will have to thoroughly
understand the diagnosis, so you should concentrate on understanding
staging, Gleason score, and the significance of the PSA. You basically
have to choose one of three alternatives: not doing anything at
present, surgery, or radiation, Both surgery and radiation would try to
cure to cure the disease. There is also hormone suppressant therapy,
but that should be reserved for men with evidence of advanced disease,
which is unlikely at present. You shouldn't worry about that. It will
just scare you and not be particularly helpful. There will be plenty
of time to consult a medical oncologist, the appropriate specialty, if
need be.
What you do next depends on a variety of factors: your age and health,
the specifics of the diagnosis, and perhaps special factors about your
case. Just waiting, also called expectant management or watchful
waiting, is primarily for men with an expected lifetime of less than 10
years or men in ill health who cannot tolerate more aggressive
treatment. Younger men with disease that is considered curable are
usually advised to choose surgery for a variety of reasons, but there
may be special reasons to choose radiation. Older men are often treated
by radiation. There are two choices for radiation: external beam or
implantation of radioactive seeds. For both surgery and seeds
(brachytherapy), the skill of the doctor is very important, both for
success in curing the disease and for avoiding side effects, For
external beam radiation, the skill of the doctor is not quite as
important, as long as an up to date method such as IMRT is used.
I was 67 at diagnosis. I was in very good health and, except for the
cancer, could expect to live at least another 15 years. I had a Gleason
7=3+4, T1C case (meaning the doctor felt nothing on digital rectal
examination) with PSA 4.5. My urologist suggested either surgery or
radiation. For various personal reasons, I chose surgery, but had I
been five years older I might have chosen radiation. Some men fear
surgery, but I didn't, and I just wanted the damn thing out, which is a
typical but not entirely rational response. My surgeon told me that at
my age with him doing the surgery my chances of being permanently
impotent were about 50 percent. Radiation couldn't do much better in
that regard at my age. The chances of being seriously incontinent were
much lower, so I didn't worry about that. Had I been five years older,
the chances of being permanently impotent would have been at least 75
percent no matter who did the surgery but only about 50 percent with
radiation. As it turned out, I am not incontinent, and I regained
erections after 18 months, with some help from Viagra. Before that we
used a pump and managed to continue our sex life at about the same
frequency as before surgery. I remain recurrence free today over 7
years later and my chances of ever having a recurrence are pretty small.
It could happen, but most likely something else will get me first, so
it doesn't make sense to worry about it. Of course, each year, I do get
a bit tense as I wait for my PSA test results.
I see you also posted to alt.support.cancer,prostate. You will probably
get lots of useful advice, but remember that it may be biased one way or
another. Also, the men who post there are more likely to have had
special problems, or, like me, they are medical junkies. As
statisticians say, the sample is skewed.