We've all been there. What you are going through right now is so typical, it is given a name - "cancer panic." It is the worst possible time to make any life changing, irrevocable decisions. You have plenty of time to calm down and make a reasonable decision. Read this:
The risk level you are at (assuming your PSA ≤ 10) is called "favorable intermediate risk." IDC doesn't raise your risk level for your Gleason score 3+4. That means that all of the available treatments have a 95+% chance of curing you right off the bat. And there is no difference between prostatectomy and radiation in cure rates. For now, decide to make no decisions.
I was only a few years older than you when I was diagnosed. Because I was still in my sexual prime and single, I didn't want to risk ED and incontinence, so surgery was off the table. I took 9 months to decide and met with 6 doctors - I'm still glad I did 14 years later.
Dont rush ! After Biopsy your prostate is inflammed. Do maybe a psma petscan before you go into surgery to be sure nothing is outside the prostate. Try to enjoy life and think about what is important to enjoy life like you want to enjoy. There is a life after treatment.
I choose surgery and until now after nearly 6 month i m happy with the choice. PSA 0.0 something. Incontinence ok quiet after removal of catheter. Penile rehab is going well. I m discovering a new sex life without own sperm.
I was diagnosed in december 22 it took me more than 6 months to decide and do the surgery in september 23. I m 58 now and still have activ sex life.
Just dont rush ! Dont let the stress choose for you !
It is very difficult to separate Medical Health, Psyochological stress, Sex and QoL.
Was Diagnosed first with a PSA 6 in september 22. Did MRI in october wich results Pirad 3 (no lesion clearly visible). Did a genetic test (says 16%...) in november and Biopsy in december. Gleason 3+4. Waited and inform me for long time. Did a new PSA in april that went down to 4.5 . And decided in July for surgery as PSA rose again. Surgery in september. PSA is now 0.0 something. Continence is ok since mid october. Was far from work and any kind of stress for 6 weeks after surgery and that helped. For all. In one word : dont let you push in a stress or hurry.
Dr. Eric Walser performed a Focal Laser Ablation on two small tumors inside of my prostate in 2015. An mri in 2016 showed re growth in that same area. We went back in 2017 for a 2nd FLA. Dr Walser said that he planned on widen the margin in order to zap remainder cancer cells. This procedure resulted in a fistula causing urine to exit through the rectum and fesses to exit through the penis. It was extremely painful and life altering for months. I had a catheter for two months while it healed. But it did heal like Dr. Walser said it would. He said he got to close to the prostate wall. He used an experimental laser on me with my permission. I agreed to it because he didn’t charge me for the laser material since it was new. Insurance didn’t pay so anything FLA was out of pocket. Representatives from the Swedish company that manufactured the laser were there, in hopes of selling there product I suppose no doubt.
Three years later in 2020 cancer popped up again in the same spot. Since I’m a glutton for punishment, I went back to Dr Walser at UTMB, this time for a cryoablation. He placed a gel spacer between the prostate and the rectum wall to help protect the old fistula damage. I found out later from speaking with other specialists that this was qunite risky. After the Cryo Ablation was done I was in a lot of pain. It took weeks to able to pee without extreme pain.
Fast forward to 2022. An mri and then a PSMA pet scan reveal the cancer had grown outside the prostate and I had bone Mets on my T2 vertebrae. I am now on ADT for life.
I was 54 when first diagnosed, I am now 63. Feel free to debate weather I should have had my prostate removed at the beginning. Maybe I should have. I opted for quality of life and it’s been a mixed bag. I could argue either but the fact remains I have advanced stage 4 prostate.
We all have to make our own decisions and we live or die by the consequences.
Almost identical situation here. 55 years old, very similar pathology. Going in for RALP in a week after taking a few months to fully explore options, gain additional data points (ie genetic testing for likelihood of aggressive cancer) and get second and third opinions from best docs I could find. Get Walsh’s book and learn all you can. There are no perfect treatments - they all suck in one way or another. Don’t let your doc or your fear make you rush into anything though - you have some time. Best of luck to you - you’re going to be fine but it might not be much fun until you are.
Right Mike ! this is a very difficult period : deciding what to do with our own life and body. Plus accepting having a tumor (even if not so agressiv).
Yup, take your time, learn the pros and cons of the various paths you can take and make a decision. IMO the most important part of decision is finding a Doc & facility that has treated thousands, not hundreds along with someone you feel comfortable .
Prostate Cancer if detected early, is not the death sentence in years past, very treatable.
53 here also very similar favorable intermediate stage. I spent a couple of months researching all the pros and cons of surgery vs. radiation and chose radiation. Let me know if I can help with any questions.
My story is almost the same as yours with one difference. One of my PSA readings was over 10 at 13 (readings for several years during “watchful waiting” period were between 7-9.5 with a large size prostate and Gleason 3+3). On my third biopsy they found a Gleason 3+4. One radiologist thought (from reading my MRI) there was a possibility that the tumor may have pushed through the capsule. So I got a PSMA PET and it revealed no spread outside my prostate. Because my PSA was once above 10, I was classified as “unfavorable intermediate risk”. Like Tall Allen I could still have sex and orgasms, so several surgeons said to go the RT route. They may also have not wanted me as a surgical patient because I was 76 years old even though I have no cardiac problems. So a year and a half ago I received proton RT (SBRT) and 6 months of Lupron. Right now, after numerous adverse side effects from the Lupron mostly related to muscle atrophy, a cure is still in sight (PSA=.07 and Testosterone is 476) and my sex life has returned at least for now. My doctor tells me that orgasms may become harder (no pun intended) to achieve because of the latent effects of radiation. But she says “at my age we may not know whether any diminishing libido will be due to the radiation or just my age”. I am 78 years old. Ain’t old age great? So far I have no urinary or fecal incontinence from the RT but sometimes those ills do not kick in for a year or 2 after the RT. I will test my PSA and T for the remainder of my life and only time will tell the story. I do not look forward to the possibility of going back on Lupron but it is kind of the gold standard to stop the disease (that is, until it doesn’t). If you elect for ADT, be sure to do as much weight training as possible. In fact, start training now while you have some testosterone in order to build extra muscles. You may need all of them you can get.
I wish you well as you discern your path. In my case, I have been very committed to a proactive regimen of nutrition, stress management, exercise and sleep over the past year. My initial biopsy was of a 3+4 but after a year it has been downgraded to 3+3. I have dumped two urologists whom I did not trust. I have ruled out surgery and prefer to continue on AS for as long as prudent. I am not recommending any particular decision but just sharing my own story as one among many. All the best.
Found a little added information. You can get multiple scoring /risk systems, Capra is a commonly used one and the Capra-S is a bit different in that it takes patients that have had RP and prognosticates based on the surgical pathology. . From the information I have with PSA 0-6 you get zero points, negative surgical margins gives 0, absence of seminal vesicle invasion gives zero, Gleason 3plus 4 gives 1, extracapsular invasion absence gives 0 and negative lymph invasion is also 0 so your Capra-s is a 1. Reading through article today PMID 37558528 and going to PMID 35676330 as well, in patients with Capra-S score of a 1 or 2 there didn't seem to be correlation with increased risk where three and above (their intermediate and high risk) did seem to have significantly worse outcome even with Gleason 3+4 if the Capra-s score was 3 or above. Nothing is perfect and cancer hasn't read the articles or textbook but I personally thought this reinforced your urologist position of not getting the toxicity from added treatment unless something changes. The PMID numbers are the pubmed numbers of the articles and just google that and you should be able to get the articles.
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Active surveillance has ended after one year. RP now recommended.
Prostate Biopsy Results
Uro and Surgeon Recommending Focal Cryoablation
Diagnosed today
Advice - Surgery or Radiation?
