My best friend from Romania

[Tippler]

Happy to see my best friend, a little bit concerned about his PC. Now I have APC. 11 years ago I was in his shoes. His PSA is 6 and the Gleason score is 6(3+3) and he has a tumor 14 mm. in diameter. He is 70 years of age and in very good general health. I had cyber knife radio surgery 12 years ago with a PSA of 0.00 for years. Now I am on Lupron and Zytiga with Prednisone. What should I tell my friend about his options? We are not sure if cyber knife radio surgery is an option in Romania. For surgery he was advised to go to Germany or Italy, maybe Austria. What would you tell your friend in this situation? Any input is greatly appreciated. He will be seen by two different Urologists in Florida to help him understand his options.

[Tall_Allen]

He seems to be a good candidate for active surveillance.

[AlanMeyer]

I think he may be a candidate for active surveillance, or maybe not. His Gleason=6, if it's accurate, is considered low risk, as is his PSA=6. His 14mm tumor, if we assume it's spherical would be between 5% and 10% of the size of a normal prostate (Volume = 4/3 pi r^3, a large prostate is said to be 30 cc). That sounds like a little more than low risk. However we don't know for sure if his Gleason is accurate, or if the tumor size is accurate, or if there are no other other tumors in the prostate.

I would think a good first step would be to find some lab that's reliable, possibly outside Romania if necessary, and send all of the reports from biopsy, MRI, or whatever diagnostic data he has, together with the biopsy slides, to get second opinions on all of that. If the second opinion confirms that he has low risk disease, then active surveillance might be the best course - but he should be "active" and not just let things go for years with no more PSA or other testing. On the other hand, if the second lab says this Gleason is more than 3+3, or the tumor is bigger than supposed, or there are more tumors than just one, then he should start a search for treatment.

Personally, although I think that Cyberknife is a fine treatment, there are many other treatments that I believe are equally effective including surgery and many other radiation modes. The main thing is to get a very good surgeon or radiation oncologist. I'd rather have brachytherapy or IMRT, or surgery, or whatever from a real expert than Cyberknife from someone who isn't a really good doctor.

Alan

[Tippler in reply to AlanMeyer]

Thank you very much for your input!

[JimVanHorn]

Hello Tippler. I live in Florida and our insurance rates are different in other countries. I did not have cyber knife radio surgery. I had radiation (42) in 2007 and my MRI showed metastases in 2011 and I had 30 more radiations and Lupron (Eligard - generic) for 6 1/2 years. I used Casodex when I started Lupron for 3 weeks to stop a Testosterone flare up. My Gleason was 4+3=7 and my PSA was 72. Now I am off of all treatment, my cancer is gone and I am on active surveillance. If your friend is interested he could use the site called "Health unlocked - Active surveillance - prostate cancer".