My dad (aged 60) has just been diagnosed with prostate cancer. He's been given a lot of information to read and he will be meeting with his care team again soon to decide on a treatment plan - the treatment options being considered are active surveillance, radiotherapy/hormones, focal therapy, and robotic radical prostatectomy.
It's looking likely that he will be going into active surveillance, but I wanted to ask if anyone has any advice on questions to ask his doctors in his next meeting? things he should be aware of? Any advice you have will be really appreciated.
Thanks!
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May1994
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Your father probably has low risk prostate cancer if they are recommending active surveillance, and it is certainly his best option. There is no standard protocol for active surveillance, but many hospitals require a confirmatory mpMRI-targeted biopsy within a year, and an annual PSA test. It is not something to do on one's own, so ask about their protocol.
My Gleason score was 4+3=7. In November last year I was diagnosed by biopsy as having cancer confined within my prostate comfortably away from the wall. From experiencing a cancer in my family, the lessons I learned was don't underestimate cancer, go fast and go hard (meaning hit it with the treatment offering the maximum chance of cure). I decided to go hard and have a robotic radical prostatectomy (which has a cure probability equal with radiation). I chose a robotic radical prostatectomy rather than radiation because radiation has side effects which appear 5 or more years later. In early January I was offered a surgery date at the end of March this year. I was a bit worried that waiting about 3 months was not going fast. So I found a urologist who could offer a surgery date at the start of March this year. After surgery the specimen microbiology discovered my prostate cancer was outside my prostate wall but inside the surgical margin. Had I waited another 4 weeks I think my prostate cancer would have been outside the surgical margin and spreading inside my body. In your dad's shoes I would ask the question: Which treatment of active surveillance, radiotherapy/hormones, focal therapy, and robotic radical prostatectomy offers the maximum chance of cure. Only if I was above 80 years, would I consider active surveillance, a treatment offering the best quality of life but has the risk that the prostate cancer may change from slow spreading to fast spreading and may spread outside the prostate which reduces the chance of cure. All the best for your dad's health.
Your dad seems to have a similar diagnosis as I had: 7(3+4), 20% grade 4, 3 tumors (2 in left lobe, 1 in right). If he has 5% or less grade 4 active surveillance is a great plan, above 5% and things start to get a bit more dicey. As a possible option he should talk to his care team about High Dose Rate Brachytherapy (HDR-BT). It is the option I chose as a mono therapy and 2.75 years post procedure I have basically no side effects, my QOL is as good or better than when I was first diagnosed at the age of 62, and it appears the cancer is gone. No matter his choice he will have the best outcome by going to a Center of Excellence and working with doctors that have preformed the procedure many, many times. There is no cure for cancer, but life long remission is attainable. If your dad can't get to a Center of Excellence look for a teaching hospital tied to a major university. Best of luck to you both.
Put off any treatment other than active surveillance as long as possible. Some who have gone through radical prostatectomy report a great life; others, like myself, wish they could undo it. Everyone is different. It'd be good to ask how agressive the growth is. Prostate cancer typically grows about as fast as grass in winter. I have found that doctors want to aggressively treat any cancer no matter how life threatening it is (or not so life threatening). Understand that most men with Prostate Cancer die of other things before the cancer has ever had a chance to take hold. My PSA was measured at around 7.0 for 3 years. So it had been well over the 4.0 benchmark for some time. The last test prior to surgery, PSA was 6.5. The only reason I got the prostatectomy was that the biopsy showed cancer in every core, gleason was 3+4 and my dad died a very painful death from prostate cancer. I did not want to suffer the way my father did. So, if your father can wait another 6 months, see what the PSA tells you and if its going up, then consider treatment. If it goes down or stays the same, then why treat something thats not getting worse?
pcf.org has an excellent publication titled Prostate Cancer Patient Guide, which you can get for free and includes a list of questions to ask your doctors.
I don’t have nearly the academic knowledge as some on this site (for which I am eternally grateful). All I can share is my own experience: the only thing I can think of to share is to consult with an oncologist who knows prostate cancer. The urologist who diagnosed my Joe recommended surgery to remove the prostate in 2009 when Joe was 56. He had radiation of the pelvic bed in 2011. When we saw the first oncologist in 2017, we were told they felt they would have adopted a watchful waiting model for awhile. As it is, the “nerve sparing” surgery wasn’t, and it changed an important part of our life forever.
Again, this is just one couple’s experience! You’ll get many, many more on this site!!
Nice thing about these seminars is that they also attach the PowerPoint slides, so if you are like me and like to read the actual studies, you don't have to pause the video to take notes.
If choosing AS, it can only be helped by a strong commitment to optimal health and wellness.
I am on AS. I went from a couple of 3+4 cores to all 3+3 in a year. I can’t know for sure what contributed but believe things like no meat, no regined sugar, exercise, sleeping well, yoga, prayer, being generally positive, etc help.
I fired urologists who were too pushy and who I did not trust and finally have a team that I trust at a major cancer center.
I am always trying to balance the value of medical professionals with my growing skepticism and cynicism about what really drives the system - money.
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