I was diagnosed with prostate cancer 8 /9 /2016. My first PSA this year was 4.32 and in 5 weeks jumped to 5.62. This triggered a biopsy test. My Gleason score was 3 - 4 with a total 7 and the other score was 3 + 3 for a 6. Then another biopsy was pre cancerous. I talked with the radiologist and he said if I get radiation my chance of impotency was about 50/50 and 5% chance of incontenence. The robotic surgeon said about 10% chance for each. Not sure what to do. I am 70 years old and very active and need no blue pills. About 23 pounds overweight but still can play racquetball weekly competetively. Any advice on what to do?
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irwinb3
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Was the originalGleason a 3+4 or was it a 4+3, and how much cancer was involved, that is the cutoff I believe between medium risk and high risk prostate cancer, lower than high risk. Often Men will choose to watch and wait with lower risk prostate cancer, change their diet and such. I am not sure if you Qualify, I am not a Dr. and do not know your stats. My suggestion is to get all your records and to see a Medical Oncologist Specializing in Prostate Cancer. A good book written by one of the best Medical Oncologist spec in PCA is "Invasion of the Prostate snatchers" By Dr. Sholtz.
Firstly, I am not a medical doctor. I was diagnosed for high risk advanced prostate cancer in March 2015 at the age of 68, taking treatment and managing my disease very well. You can click on my name and see my detailed profile. Please try to fill up your case too with the key pathological details to afford anyone in our group to help you with more meaningful answers to your questions.
Please appreciate Dan's reply which has very good points for you. Try to learn as fast as you can from all possible sources on Prostate Cancer.
To begin with, be cool, maintain a positive attitude at all times but be serious when you are making decisions after having been diagnosed with Prostate Cancer ( For that matter any cancer, because cancer is a terminal disease ). But today, if identified early and treated properly with highly developed protocols cancer can be cured or at least put to long term remission so that you can live your full life cancer/symptoms free. That means you may die with cancer but not of cancer.
Coming to the specific questions you have asked if I were you first I will try to be clear in my mind in such a serious situation. What is most important for me? To ensure living my full life without being destroyed by the prostate cancer or retain my ability to enjoy sex? ( incontinence is a simple issue to tackle physically and psychologically ). At the age of 70 I would certainly choose to live cancer free. Your Radiologist is dead right, 50/50 chances ( That is also because your case is medium risk ). Again considering the medium risk factor in your favour, what your Med. Onco. has told is also correct. The difference is because, these are two different types of treatment protocols with significantly different side effects. Both are good gold standard CURATIVE treatments and I would advise you not to miss them ( one or both ). " Watchful waiting" is not a very wise act. For a prostate cancer whether slow growing or fast growing, one must do everything possible hoping for a cure. Earliest opportunities are the best and not to miss and regret later. With a lethal cancer ( slow growing or fast growing ) no one can predict accurately what will happen. Your present medium risk status may become very unfavourable if you don't act fast. Even the above predictions may change demanding for more aggressive treatments associated with significant side effects. Impotence and incontinence are the two most common issues in treating prostate cancer ( incidence is high in the former ) but there are treatments for these side effects.
Once again, if I were you the pertinent question I would ask from myself or from the doctors is whether these treatments will cure my prostate cancer? Normally, doctors won't give a definite answer, but it should remain as the most important question and you must work out your plans towards this goal.
I have received both these treatments plus Androgen Deprivation Therapy ( Hormone Therapy ), that means double castrated - 100% impotent ( Trouble free and very happy! ) but 100% continent.
Pay special attention to select highly skilled Urological Surgeons, Radiologists and Oncologists specializing in treating prostate cancer only - This is very important.
You are not alone for more than one reason. Most importantly you are with an excellent group now. We are here to help each other.
The best piece of advice I can humbly give you is to go and see a medical oncologist, preferably one who specializes in prostate cancer. As Dan59 said previously get informed and the book he recommended is a good beginning. Good luck matey!
My history is similar at least at the onset. My approach was to follow a fail-safe treatment approach. This means I ranked the treatments available so that if the first failed I would be able to go to the next one. Thus, I selected the robotic surgery since if it failed I could go to radiation (can not do the reverse.) In my case, the cancer was derived from Agent Orange exposure and was aggressive. Sure enough, PSA rose after surgery so then had 43 radiation treatment. That failed and now I am on Lupron. I am over four years from first treatment and still vertical. I am able to work on my farm (age 77) but suffer with some pain and fatigue. Life is enjoyable in different ways from prior to treatment. Sex is but a memory. My Doctors have generally been of "great expectations", but not all the "frills" were delivered. Bottom line: expect that life will be different, but it can still be dear. Blessings and good luck!
Take vitamin d3 (I say this to everyone), lose the weight (stop eating sugar for sure and carbs as well), and exercise. But specifically, do you know your testosterone level? There is a good deal of thought that it is Castration Resistant PC that cranks the risk up.
And that people should have a normal testosterone level, at least until they decide to pursue an ADT path.
There is a class of people for whom ADT does extend life. That is pretty well known. Once you head down the ADT path, you are heading into CRPC territory. So you will also need a Plan B.
I don't know your location but my advice is to find a Proton Radiation Center, not a photon one, but a Proton. Have them look at you pathology reports and medical record and see if they can help you. Look Proton radiation up online and read about it. It is the least invasive and fewer side effects. The Proton radiations pinpoints and destroys the cancer cells and doesn't damage the good cells. Also they can control the depth and accuracy of the laser beam. It doesn't go through you like photon radiation does. My closes center is Provisions Center for Proton Therapy in Knoxville, TN. Check it out.
All the other comments already made are excellent. I would add the following: you need to get a second opinion on the biopsy. It is easy to have done and is usually covered by insurance. You would be shocked to see how often second pathology differs from the original, pathology reports are subjective, not objective. If you go to our (Malecare) web site at Malecare.org) click on the tab second opinions on biopsies for directions on how to get the second opinion as well as recommended labs.
As has been mentioned in a prior response we also (in addition to the second opinion) need very specific information about the biopsy findings, like how many cores were taken, how many were positive and in the positive cores what was the percentage of cancer in the cores.
Given your age you might be a good candidate for active surveillance which will have a much smaller quality of life implication.
Take your time in making any treatment decision, you have the time. Get the 2nd opinion and supply us with additional information.
By the way, don't hang your hat on the quoted chances of incontinence and erectile dysfunction. Nobody can predict what your response will be (other then no matter what treatment you do choose there will be some effect). They might be very honest, but there is no standard measures of what is incontinence and erectile dysfunction, so what one doc calls erectile dysfunction another might not call it anything.
My 73 year old friend went to Brandenburg (sp?) and got his prostate super-heated to kill all cells in the prostate. However, his nerves were spared and he does not have ED. If I were to start all over again, this is what I would do. He spent less than money overall than I did with just co-pays and unqualified (for health insurance) expenses!!
What you are describing is the option I selected -- HIFU-- high intensity focused ultrasound. I was gleason 8 but CT and bone scans showed no signs of metastasis. My PSA was in the normal range of 2.7 but tumor was very palpable on the DRE exam. I was not a candidate for surgery after prior TURP (roto-rooter) surgery for enlarged prostate. TURP is a positive for HIFU treatment. Medicare and insurance is not yet 'coded up' to approve and pay for this. FDA approved it last Oct which allows its availability now in the states. The surgeon I went to had plenty of prior experience treating US patients in Mexico or the Caribbean. I'm not a doctor but will furnish my opinion on radiation vs HIFU: radiation is a blunt instrument, HIFU is a precision instrument that provides the surgeon real time imaging of the tissue he is happily heating up to 200 degF as he goes. I am age 66. I am 2 weeks post procedure and I am still wearing a supra-pubic catheter. Waiting for the tissue swelling to go down to restore normal urination.
As Dan59 mentioned, see a "Medical Oncologist Specializing in Prostate Cancer" (do not rush into options right now). If you are located in the New York City area see one at Sloan Kettering. Good Luck and Good Health.
I was a Gleason 7 (4+3) about 4 years ago. I went to the best and most experienced robotic nerve sparing surgeon in my area ( Dr Samadi Lenox Hills NY ) and removed this monster from my body. I'm still cancer free , psa undetectable, enjoying sex with with my wife , and no urine problems. My advise is to not waist time. Prostate cancer could be the best cancer to have if you act on it quickly. You are a perfect candidate to have an experienced surgeon cure you with very little side effects. Don't loose this opportunity. God luck and god bless.
Lots of good posts. My only advice is don't panic and rush into anything. You have plenty of time to research and talk to doctors and patients like us before you choose a treatment. Good luck.
I am of the opinion that your age is in your favor! A number of my 'mature' buddies have opted to go for brachytherapy with very good outcomes. They are all still alive and doing well. MD Anderson Cancer Center in Houston has been doing that procedure for many years. My biggest concern was incontinence...impotency is far easier to live with. I myself chose an RP since I was eight years younger and had a Gleason of 4+4.
I have just recently joined this forum and find it very informative.
Sorry to hear about your friend Kent...your kind words are heartfelt! Thanks for the input.
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