Newly diagnosed

[ArizonaMike]

Hello, I am 58 , Gleason score 7 (4+3), Stage 1. Newly diagnosed with 2 main options given to me: Radioactive seeds or Robot Prostatectomy. Apparently after the radioactive treatment, the cancer could return & removal of the prostate is no longer an option. Removal would likely completely take care of the issue as it is fairly small & hasn't spread outside the prostate. Because of my age the Doctor said waiting is not a good option since it will only get larger with time. He says to take care of it now while it is small. Thanks for any advice!

[Tall_Allen]

Please read:

healthunlocked.com/prostate...

Those are not your best options.

[ArizonaMike in reply to Tall_Allen]

Thanks, reading the post you suggested I don't see where the removal is not the best option ( since it is contained to prostrate & small at this point). Thanks

[Tall_Allen in reply to ArizonaMike]

You have to read the links, especially this one:

pcnrv.blogspot.com/2018/10/...

"After a median follow-up of 6.9 years, the 7-year biochemical recurrence-free survival was:

•low risk: 95.5%

•favorable intermediate risk: 91.4%

•unfavorable intermediate risk: 85.1%

•all intermediate risk: 89.8%

Low risk patients and some of the favorable intermediate risk patients would probably be diverted to active surveillance today. The 7-year intermediate risk biochemical recurrence-free survival compares favorably with (note: this is not a randomized comparison, which is the only valid way of comparing):

• Surgery: favorable intermediate risk (PSA=6.0, T1c, GS 3+4, 33% cancerous cores): 81% (mean of 5 and 10-yr Progression-free survival) (1)

• Surgery: unfavorable intermediate risk (PSA=6.0, T1c, GS 4+3, 67% cancerous cores): 53% (mean of 5 and 10-yr Progression-free survival) (1)

• Hypofractionated IMRT (5 year): 85% (2)

• Conventional IMRT (5 year): 85% (2)

• Low dose rate brachytherapy: favorable intermediate risk (avg of 5 and 10-yr): 85% (3)

• Low dose rate brachytherapy: unfavorable intermediate risk (5-year): 81% (3)

• Brachy boost therapy: unfavorable intermediate risk (10 year): 92% (4)"

Your statement that "it is contained in the prostate..." is certainly a hope, but that is all it can be at this point. "Unfavorable intermediate risk" means that there is significant probability that it is not contained in the prostate. One man in my support group had only one core with a small amount of high Gleason score found only on a second biopsy. Unfortunately, despite appearances, it had already metastasized, which only became apparent 2 years later.

[ArizonaMike in reply to Tall_Allen]

Thanks, I appreciate the info very much!

[Harley1948]

Think You are similar to my biopsy. I opted for removal and my pathology report showed a positive margin and EPE. Glad I had it removed. ART was a follow-up based on my pathology report. You can read my info in my only post.

[Fairway]

Hi Arizona,

Writing just to offer my support and best wishes. I was 70 when receiving similar advice from docs. I had the prostate removed. Though I had, and have, subsequent problems with impotence and incontinence I don't regret the action. Just be aware that either or both of those things can happen no matter how good your surgeon, and I'm told mine was one of the best. You're doing the right thing by getting different opinions on the matter.

[Vike]

ArizonaMike I was faced with the same choices and chose to have surgery. I was 68 at the time so a little different than you. Two years down the road I am cancer free and feeling great. My reason for choosing surgery was I wanted to be one and done. The two big issues post surgery are incontinence and ED. The incontinence was not an issue for me. Within a few months I was back to normal control. The ED was another issue. Unfortunately for me I have not returned to normal erections. Please talk to your surgeon if you choose that route regarding nerve sparing. It is an important element of your specific surgery.

[aceace12]

please get second and third opinion ,,, good luck