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Old 02-02-2011, 03:26 PM   #1
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A New Club Member

I had my Prostate biopsy performed on 21 January 11, turned 60 the next day. An interesting way to celebrate ones birthday, you think? I received the results the following Thursday night around 8p. I don't know about you, but when a Dr call me at that hour I know it is not for good news. Out of all this I received a Gleason score of 6, 8 samples on each side, 4 of 8 positive on the right side or 20%, I think 1 (maybe 2) of 8 positive on the Lft side or >5%. I have been having PSA checks for several years and have reciently crossed over the upper limit on an acceptable PSA Score. So I believe it was just over 4. I don't remember how much, but the Dr said it was not very much. I became a widower 12 months ago, so I do not have the partner help and support many do. The U Dr said "It needs to be removed", I said not so fast!. My family Dr said Isotope or B- whatever therapy. I know, I'm highly technical. Obviously I am still learning about all this and trying to sort it all out. After listening to the U Dr for about an hour going over all the treatment options less Proton and Cyberknife. I politely asked him when he was going to get to the good options cause all the ones I heard about sucked. I thought that since this was caught early how hard could it be? Yikes! way complicated. I am doing due dilligence, I have requested and recieved Proton treatment data from Jacksonville, Fl and Bloomington, In and am starting to go over all that. I have the Radiation Oncologist consult on Tuesday. Have been looking for people who have gone before me and have experienced whatever they did. I have the appointment with the Dr next Thursday as to what I want to do. I can honestly say with confidence, I have no clue. My leanings are to have it removed De Vinci style (or not), Proton sounds good too. My argument is I would like all my moving parts to work. And would like the best option to achieve that end. To be honest, reading all the stuff on the board scares the living hell out of me. I have been married all of my adult life, I get to this point, 60, a widower, and they want to do what? and with what results? You have got to be kidding. I am still reading, listening, searching, reading some more, trying to figure it all out, as I can tell from the many posts, is a confusing mess. No one makes it easy. So, like everyone else, what does a single, reciently starting to date, 60 yr old, in sorta reasonable physical shape do?

 
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Old 02-02-2011, 04:29 PM   #2
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Re: A New Club Member

Hi jwr2992,

I'm so sorry you have had to join us, but welcome to the Board anyway! We're a good group. I'll put some comments in green in excerpts from your post.

[QUOTE=jwr2992;4675523]I had my Prostate biopsy performed on 21 January 11, turned 60 the next day.... Out of all this I received a Gleason score of 6, 8 samples on each side, 4 of 8 positive on the right side or 20%, I think 1 (maybe 2) of 8 positive on the Lft side or >5%. I have been having PSA checks for several years and have reciently crossed over the upper limit on an acceptable PSA Score. So I believe it was just over 4. I don't remember how much, but the Dr said it was not very much. I became a widower 12 months ago, so I do not have the partner help and support many do.

I'm sorry for your loss of your wife.

[QUOTE] The U Dr said "It needs to be removed", I said not so fast!. My family Dr said Isotope or B- whatever therapy. I know, I'm highly technical. Obviously I am still learning about all this and trying to sort it all out. After listening to the U Dr for about an hour going over all the treatment options less Proton and Cyberknife. I politely asked him when he was going to get to the good options cause all the ones I heard about sucked. I thought that since this was caught early how hard could it be?"

It takes some time and effort to get adequately up to speed on the options so you can make a truly informed decision. Here are two outstanding books for getting oriented: "Invasion of the Prostate Snatchers -- No More Unnecessary Biopsies, Radical Treatment or Loss of Sexual Potency," by Ralph Blum and Dr. Mark Scholz (2010), and "A Primer on Prostate Cancer -- The Empowered Patient's Guide," by Dr. Stephen B. Strum and Donna Pogliano. The former is an easy read but highly expert, while the second is equally expert but full of technical details, great graphics, and informative photos. Just to get a quick snapshot of success from recurrence figures for various therapies according to published medical research, check publications from the Prostate Cancer Treatment Center. In their "prostate cancer" files they have a publication with great graphics from the work of the Prostate Cancer Results Study Group, a group of experts.


Quote:
Yikes! way complicated. I am doing due dilligence, I have requested and recieved Proton treatment data from Jacksonville, Fl and Bloomington, In and am starting to go over all that. I have the Radiation Oncologist consult on Tuesday. Have been looking for people who have gone before me and have experienced whatever they did.
Regarding radiation, in addition to the graphic results displayed by the Prostate Cancer Results Study Group, eminent radiation doctor Michael Dattoli has written a long section of a book entitled "Surviving Prostate Cancer without Surgery -- The New Gold Standard Therapy that Can Save Your Life and Lifestyle (Cash and Kaltenbach also authoring sections). It discusses established therapies and advises what to look for. Some therapies are very strong on hype but lack the record of success that we want to see.

Quote:
I have the appointment with the Dr next Thursday as to what I want to do. I can honestly say with confidence, I have no clue.
If you decided next Thursday, you would have moved with lightning speed but without the time needed to make a truly sound choice. You need to give yourself some time. It appears your case is in the low-risk area, almost low enough for active surveillance (AS) (except for the percentage of positive cores); your age should not be considered a problem, though some docs are not up-to-speed on that yet for AS).

Quote:
My leanings are to have it removed De Vinci style (or not), Proton sounds good too. My argument is I would like all my moving parts to work. And would like the best option to achieve that end.
I was disappointed to see that one proton facility tried to make its outcomes look better by comparing its side effect results and effectiveness results to old style, clearly inadequate radiation options. That's misleading! These, days, at a center of excellence for seeds or IMRT, its difficult to improve on the efficacy and side effect results, a fact well supported by multiple, long-term studies from a number of institutions. That said, some patients come to feel that proton will give them the best shot.

Quote:
.... I am still reading, listening, searching, reading some more, trying to figure it all out, as I can tell from the many posts, is a confusing mess. No one makes it easy. So, like everyone else, what does a single, reciently starting to date, 60 yr old, in sorta reasonable physical shape do?
In two words, become empowered!

Take care and good luck,

Jim

 
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Old 02-02-2011, 07:51 PM   #3
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Re: A New Club Member

I think you have too much on both sides for AS, imho. My favorites right now are CyberKnife and pencil-beam proton.
- Allen

 
Old 02-03-2011, 02:31 AM   #4
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Re: A New Club Member

Hi jwr2992,

I am sorry to hear about the death of your wife. You have no partner but you are not alone in this problematic path of prostate cancer. Many guys here and at other forums will help you in understanding its complications.

Gleason score 6 classifies you almost in the group of “low risk patients” and that is a type of cancer that usually grows slowly which gives you enough time (3 months) to educate yourself about your status, treatment options and their side effects.
Gs6 is also the group to who almost all treatments have shown a high margin of success. To have a wider picture of your status, you will need and should report to our fellows, other information from the pathologist report on the biopsy (extra capsular extention), as well a PSA chronology, DRE, and results from any image study. A second opinion on the samples done in a reliable laboratory is also recommended to avoid uncertainties.

Hopefully you have educated yourself in the process while consulting for the best treatment. Urologists, radiologists and oncologists will all give you opinions based on their expertise. The final choice will be at your hands. Do not rush if not prepared yet.

I wish you the best.
Baptista

 
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Old 02-03-2011, 06:01 AM   #5
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Re: A New Club Member

Hi Jwr,

I too am sad for your loss. As others have said, we have a good group here. I hope we can help you a bit with these tough decisions.

Because your treatment choice depends on knowing your cancer stage, you'll want to get that information squared away. It sounds like you have a lot of the information you need. Let me just talk about two things that others have not mentioned yet. First, your Gleason score sounds great, but if the pathology report wasn't done by an expert, it might not be accurate. If you have doubts or want to be extra sure, you can consult the books mentioned by Jim to find an expert pathologist to send your slides to for a second opinion. If your score were to go up 1 or 2 points, treatment considerations might change.

A second point is my current hobby horse, mainly because I was a victim of this. You want to know where your cancer is in the prostate before going into surgery. In particular, you want to know the chances, if the cancer is removed, that some may have been left behind at the point where the prostate was detached. This usually happens at the apex of the prostate which attaches to the urethra, and is called "positive margins." If some is left behind, there will only be a 50% chance that the surgery will be curative, and if the cancer comes back, you'll have to undergo radiation and/or other therapy you may have hoped to avoid. Essentially you'll have gone through the risks and travails of surgery for little gain. This is a question you might want answered by the urologist before signing on the dotted line.

Best wishes,
Tom

Last edited by Gleason9; 02-03-2011 at 06:02 AM. Reason: Fixed awkward sentence

 
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Old 02-03-2011, 07:26 AM   #6
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Thank you for your kind words and words of advise about the PC treatments. I will type in the pathology reports a little later today when I get home from work. They are fairly short and sorta informative. I have not been informed of where the cancer is within. The Jacksonville Florida group send me the book ("You can beat Prostate Cancer" by Robert J. Marckini, with the packet they wanted me to read and fill out. I started reading that book last night. After the great response I got from the forum members, I was going to reschedule the Dr appointment, but after reading the responses to my post I will go just to learn the answers to the following questions: 1. where is the c located 2. how many DV procedures has he completed? 3. what are the stats for his performed procedures. 3 what are his stats for the open procedure I'm sure he must have performed. (Your question here to add to the list more informed Forum members than I are requested to help add questions to the list.) As always, Any help or suggestions are alway appreciated. I am trying to move past the shock mode of the anouncement and into the empowerment mode mentioned previously. Once again, thank you for your advise and guidance.

 
Old 02-03-2011, 08:47 AM   #7
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Below are the biopsy pathology reports given to me by the U Dr.

Right prostate (multiple needle core biopsies) adenocarcinoma, gleason score 6 (3+3) - tumor present in three of eight cores and involves approximately 20% of tissue volume
Left prostate (multiple needle core biopsies) - adenocarcinoma, gleason score 6 (3+3) - tumor present in one of eight coes and involves less than 5% of tissue volume. Sample collected 1/21/11; received 1/24/11;
reported 1/26/11.

I was also told that it was a T1c or arguably a T2c. I still have no idea as to the location from the above information, and I am trying to find out.

 
Old 02-03-2011, 12:34 PM   #8
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Re: A New Club Member

I am also sad for your loss. I finished treatment April 2010. My account is similar to yours. PSA was 4.4. Doc thought is was an infection but after the antibiotic regiment PSA went to 4.6. So the biopsy. Doc thought he wouldn't find anything. Of the samples taken, We found 3 on the right and 3 on the left that had cancer cells each at 5%. I was glad that we caught this early. The Gleason score was 6, wish it was lower but still not bad. My urologist wanted to operate immediately but I said no and did my due diligence. I ended up going with EBRT. Things are well now, I've relatively no side effects except the urgency to urinate or other bodily functions. I am told that as we move further from the treatment these should lessen. There is no sign of cancer. 1 year check up coming soon. At discovery Doc gave me a book "100 Questions about Prostate Cancer". This was helpful in my decision. It laid out all the available treatments and side effects. It was good because of the question format. All the questions that I would ask were in the book and the answer to those questions. I decided to go with radiation therapy because of my age (50 at the time) and the prognosis for the other therapies. My niece is a nurse at Duke Univ. Hospital and told me of another treatment that is not available in US but is in clinical studies, It's called Hifu. I wish you all the best with your decision and treatment. It actually get's easier as you go along but there is nothing like the search for the proper treatment. Remember with radiation therapy the soft tissue will regenerate. The radiation only kills the cancer. All the best in your decision.

Last edited by Juneymoon; 02-03-2011 at 12:45 PM.

 
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Old 02-03-2011, 04:29 PM   #9
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Re: A New Club Member

Hi again jwr2992,

I'm responding to your earlier post today of 10:47 AM. These details are actually very good news, a key change on the positive biopsy core count, but a lingering question about the stage. The significance is that it's looking more like active surveillance deserves a lot of attention in your thinking about options, based on what you know at the moment. I'll insert some comments in green following excerpts from your post.


Quote:
Originally Posted by jwr2992 View Post
Below are the biopsy pathology reports given to me by the U Dr.

Right prostate (multiple needle core biopsies) adenocarcinoma, gleason score 6 (3+3) - tumor present in three of eight cores and involves approximately 20% of tissue volume
Left prostate (multiple needle core biopsies) - adenocarcinoma, gleason score 6 (3+3) - tumor present in one of eight coes and involves less than 5% of tissue volume. Sample collected 1/21/11; received 1/24/11;
reported 1/26/11.

I was also told that it was a T1c or arguably a T2c. I still have no idea as to the location from the above information, and I am trying to find out.[/
Here's how your results break down against the consensus criteria for active surveillance (AS) developed by a group of experts.

PSA: you said earlier it was about 4. AS experts are looking for a PSA less than 10, so you qualify here. It would be wise to get a copy of your last PSA report.

Gleason Score: your Gleason of 3+3=6 is very common, and it is within the <7 limit the experts want. (Sometimes they go up to a 3+4=7, or even a full 7 with some other serious medical conditions.) However, as noted in an earlier comment, it's important that that Gleason be determined by an expert. Often Gleasons reported by general pathologists are upgraded (and sometimes downgraded) when done by experts.

Percentage of positive cores: you had 3+1=4 cores positive out of 16, or 25%. That is clearly below the 34% limit the experts are looking for. (While not listed in the consensus summary, many doctors are also looking for not more than 50% cancer in any one core.)

Stage: You heard that you had arguably either T1c or T2c. Technically, since you had a positive core on the left side plus three on the right, you had a biopsy with cancer on both sides, making it a T2c. However, with quite a few cores taken, more than is typical, only that one core was found on the left, and it had minimal cancer. I think that's why the doctor feels that T2c may be too heavy a designator. The AS experts want no more than a T2a, (on one side, can be felt, but half of a lobe or less), so your stage might qualify. However, as an earlier response noted, this is stretching the limits a bit.

PSA Density (PSAD): You do not know this yet, but you should be able to get the figures from the biopsy record or DRE report. PSAD is the PSA divided by the size of the prostate in cc. AS experts want it to be less than .15.

PSA Velocity (PSAV): This is how fast the PSA is rising in a year. Can you get any of those earlier tests, especially the most recent previous test? The experts are looking for a PSAV of <1.

The idea behind these criteria is that the patient should satisfy all of them to be eligible. Each criterion separately is not that reliable, but together they are powerful in suggesting whether a patient will be successful with AS. In practice, it looks like there is some leeway depending on overall circumstances, but risk increases a bit, of course. Still, a more aggressive but stealthy case should be smoked out early by the diligent monitoring that is done.

Active surveillance offers some key advantages with little risk. Large active surveillance programs have evidence that those AS patients who are later found to have cancer that is aggressive enough to warrant treatment, have virtually the same odds of success as men treated shortly after diagnosis. It's looking like about 70% of AS patients are able to defer treatment for many years, with some deferring it throughout their remaining years. The 30% or so who do need treatment are usually found to need treatment by the end of the second year. Patients on AS gain good years of life that are unburdened by side effects of treatment, a key advantage. During that time they can employ lifestyle tactics (diet/nutrition/supplements, exercise, and stress reduction) to help a bit in combatting the cancer, and sometimes PSA declines as a result.

During that time it is a virtual certainty that treatment and case management strategies will continue to improve, as will knowledge about success rates for each of the therapies. Here are three key examples: it is now clear that well-done brachytherapy results in extremely high success rates that are durable over many years, well over a decade, at least as good as any other therapy and demonstrated over longer periods. For the first time we have impressive five year (median follow-up) success rates and side effect data for SBRT, often delivered with the CyberKnife system; just months ago we only had published reports for three years of median follow-up, which was dicey, because you really need to see five years for radiation before ratcheting up your confidence. On the downside, our once high hopes for HIFU (High Intensity Focused Ultrasound), mentioned previously, have been diminished by a steady string of discouraging reports from different leading practices around the globe; HIFU success looks okay at one year, at two years, and even at three years, but reports with five years of median follow-up are discouraging. I believe there is not a single encouraging report when the results are compared to results being achieved by other therapies at the point of a minimum of five years of average (median) follow-up. On the other hand, HIFU is a young therapy, and if a patient is on AS for five or six years, we may be seeing some good reports by that time.

AS has been heavily researched, and there are at least six major prostate cancer treating centers with major AS programs. (All of these centers are also known for their surgical expertise; I'm impressed that many leading surgeons are now guiding many of their patients toward AS.) You can see an abundance of papers on AS on PubMed, including a number with trial results from the major centers. There have been previous posts about this, and I can give you specific leads if you would like. There have also been previous threads about changes in guidelines from major medical associations to encourage AS use, and those, too are available.

I don't mean to get your hopes up too high that you can defer treatment at little risk, but it looks like it is a possibility. If you are interested, the Prostate Cancer Research Institute has published a concise bifold pamphlet that outlines the issues and provides some references. The best explanation I've seen is in the new book "Invasion of the Prostate Snatchers." If you decide you are interested in AS, you might want to have a color Doppler exam done to check the fairly precise location in three dimensions, shape, vascularity (blood supply to the tumor) and certain other features. "Invasion" does a good job describing this. This could be especially important because of that one small positive core sample on the left that technically tips the scales to a T2c.

If AS is not the course you choose, your biopsy report opens up all the other options that have been previously mentioned.

Take care,

Jim

 
Old 02-04-2011, 06:49 AM   #10
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Re: A New Club Member

Some additional information:
Dr. has been doing the DV surgery for 3.5 yrs or 140-150 procedures.
PSA 4.09 PSA History - 2.6 in 05; 2.9 in 08; 3.5 in 10; and 4.09 in 11
Location of cancer is unknown other than it's in the prostate
he is quoting:
1-2% of incontinance issues that are correctable
50% of having an erection, depending on if you are the glass 1/2 full or 1/2 empty kind of person.
U Dr said there were 3 goals; 1 cure the cancer, 2 contenancy, 3 potency.
so it falls out this way to the goals 1. 100% cure, 2. 1-2% of permenant issues, 3. 50% either way: eek:. Where do I sign up for all this?
U Dr. Quote: "AS is not an option as it was confirmed that I have cancer by biopsy."

 
Old 02-04-2011, 07:56 AM   #11
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Re: A New Club Member

Hi again,

Don't panic. You have time to find the right solution. I think you should consult other doctors, including either a medical oncologist specializing in prostate cancer, for an unbiased view of your options, or a radiation oncologist who will at least give you the other side of the coin.

Your doctor seems a bit flippant and hasty to me. Surgery isn't the only cure possibility, and in light of Jim's excellent post, the statement about AS being ruled out because you have tested positive for cancer seems ludicrous. By the way, I went the surgery route and came out okay -- except for my positive margins , but I wouldn't say it is the "way to go" for you or others necessarily.

Surgeons also seem a bit lackadaisical about positive margins, as in "oops! oh my gosh, look what I found!" Well, a doppler ultrasound or other tests can do a better job of finding the location of the cancer to see if the surgery would end in "oops." Positive margins are a result you do not want to face after six weeks of recovery from surgery, paying all the bills, facing erectile dysfunction, and learning all over how to pee. One more point about surgery: yes, it does let the doctor actually evaluate the prostate and nearby lymph nodes, so you do learn more; but they don't take any of the pelvic lymph nodes, which are some of the first where the cancer might spread, so the lymph node biopsy won't be conclusive.

If you want the best results, you can't go wrong by consulting a prostate cancer specialist. There are a few around the country, most of whom have written books like the ones Jim mentioned. Many great research centers also have good programs with great specialists. Regardless of where you choose to go, you should see what some other doctors say.

Looking at your stage, I think you're in pretty good shape. It looks like the cancer has been caught early enough to ensure that it will be dealt with effectively.

Best of luck,
Tom

 
Old 02-04-2011, 11:26 AM   #12
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Re: A New Club Member

Hi again jwr2992,

I'm posting in response to your post just before Tom's (Gleason9) great response. He made some really key points that I hope you will take to heart. I'll reinforce some of those points below and add a few thoughts.


Quote:
Originally Posted by jwr2992 View Post
Some additional information:
Dr. has been doing the DV surgery for 3.5 yrs or 140-150 procedures.
There have been a number of published medical research studies on the learning curve for robotic prostatectomy. Unfortunately, having looked at abstracts of several of those studies and heard talks highlighting them, 140-150 procedures would suggest that this doctor, unless he is exceptionally more talented than his peers, is still on the learning curve. That means that there is a substantially increased chance of an error occuring that will cause you significant problems. We have had about ten men talk about their robotic RP outcomes at our support and education group. All but one have been enthusiastic, but that one had a miserable outcome; his prospects for improvement are not that good.

You can do your own research easily, putting your tax dollars to work for you! Go to www.pubmed.gov, a site we can use on this board because it is Government sponsored, and search for (without the quotation marks) " robotic prostatectomy AND outcome ". That just gave me 4,433 hits, a few too many. Try it by adding " AND learning curve ", so the full string would be "robotic prostatectomy AND outcome AND learning curve ". That produced 105 hits. What you really need to see are papers with results, not just opinions. Try the "Limits" feature. Just click on the Limits button, and check off the boxes for clinical trails, males, and abstracts. That reduces the list to just 17. The fourth hit includes a paper with Dr. Guillonneau as the senior (last) author. He is the doctor who pioneered the procedure.


Quote:
PSA 4.09 PSA History - 2.6 in 05; 2.9 in 08; 3.5 in 10; and 4.09 in 11
You can chalk up one more important low-risk feature for yourself. In the mid-2000s papers were published demonstrating that the PSA velocity PSAV prior to diagnosis was important in indicating the seriousness of the case. In essence, research established a "cut point" (the point above which higher or lower scores make a significant difference) of a PSAV of over 2.0 in the year prior to diagnosis. The eminent research team found that a PSAV of more than 2.0 indicated a generally more aggressive case, in addition to the risk already indicated by the stage, PSA level, and Gleason score. Similarly, a PSAV of 2.0 or lower (<=2.0) indicated a less aggressive case. Your PSAV appears to have been about 1.4 in the year before diagnosis, depending on the dates, but is clearly well below 2.0. You can read highlights from the research in a thread entitled "PSA Velocity >2 and assessing seriousness of prostate cancer," posted initially on 5/31/2009. The post mentions the endorsement of the American Urological Association.

Quote:
...
he [the doctor] is quoting:
1-2% of incontinance issues that are correctable
50% of having an erection, depending on if you are the glass 1/2 full or 1/2 empty kind of person.
Whew! Is he ever cherry-picking his research to quote to you! It's likely you can find such findings somewhere, but it's important to realize that the definition of incontinence and potency matter greatly! For example, some studies define full continence as present when the patient needs no more than one pad a day. Some studies define potency as any kind of erection, even if not sufficient for penetration.

Moreover, those statistics are almost certainly from a study in which this doctor was not involved, probably a study based on results from the very best doctors. It's likely he does not go to the considerable effort needed to diligently track results for his own patients.

I'm looking at a table in the 2001 book by Dr. Patrick Walsh, MD, arguably the premier prostatectomy surgeon in the world. Results for Johns Hopkins, with his results probably dominating, show "no pad" continence for 93% of men at the 18 months post surgery point, and they show an 86% rate for potency at that point, with 33% using Viagra.

However, for years Dr. Walsh focused on patients with quite low-risk case characteristics; I'm thinking they were also probably on the younger side. Here's a paper with eminent surgeon Peter Scardino as the senior author, from 1996:

J Urol. 1996 Nov;156(5):1707-13.
Risk factors for urinary incontinence after radical prostatectomy.
Eastham JA, Kattan MW, Rogers E, Goad JR, Ohori M, Boone TB, Scardino PT.
Matsunaga-Conte Prostate Cancer Research Center, Baylor College of Medicine, Houston, Texas, USA.

PURPOSE: We identified risk factors associated with urinary incontinence after radical retropubic prostatectomy.

MATERIALS AND METHODS: The time from operation until urinary continence was achieved was determined by chart review and questionnaire in 581 patients who were continent before undergoing radical retropubic prostatectomy between 1983 and 1994. ...

RESULTS: The actuarial rate of urinary continence at 24 months was 91% for the entire patient population and 95% for those treated after 1990....


I think it's likely this pool of patients was broader in risk and age than the patients reported by Dr. Walsh. The real odds for most patients probably fall somewhere below the Walsh and Scardino results.

I strongly recommend that you read the new book "Invasion of the Prostate Snatchers" (Blum and Scholz). For instance, on page 44 it notes that after surgery "only 5% report that their erections are as good as before surgery" (based on Harin Padma-Nathan, Postoperative nightly administration of sildenafil citrate significangly improves the return of normal spontaneous erectile function after bilateral nerve-sparing radical prostatectomy. Journal of Urology, Abstract 1402, 2003.) The book also notes that penis shrinkage of about a half inch is common, with some having "considerably greater shrinkage" (based on Marc Savoie, A prospective study measuring penile length in men treated with radical prostatectomy for prostate cancer. Journal of Urology, April 2003). Regarding incontinence, the book reports: "The best urologists report that about 7% of their patients are left with permanent and constant urinary drainage [footnote 9]. Less-skilled surgeons have much higher rates. After surgery, most men experience some leakage whenever they cough, lift, bend over or simply laugh." (based on Paul Lang, Views from the "other side": Personal reflections about prostate cancer from two urological oncologists: Prostate Cancer: Principles and Practice, April 2006)


Quote:
U Dr said there were 3 goals; 1 cure the cancer, 2 contenancy, 3 potency.

Quote:
so it falls out this way to the goals 1. 100% cure, 2. 1-2% of permenant issues, 3. 50% either way: eek:. Where do I sign up for all this?
I would rather not present these less encouraging numbers, but I'm convinced it helps us all if we go into this experience with more realistic expectations. The side effects are well worth it if the cancer truly needs to be controlled by major treatment. For low-risk patients and treatment by competent doctors with good facility support, treatment is almost certain to do the job. The critical question is whether it is necessary for a specific patient, in this case, you.

Quote:
U Dr. Quote: "AS is not an option as it was confirmed that I have cancer by biopsy."
I like Tom's take on this one. Unfortunately, it suggests strongly that the doctor does not understand active surveillance, which is for low- and very-low risk patients who do have prostate cancer, and even for some intermediate risk patients with other health situations that are serious. In view of major endorsements of AS by the American Urological Association and the National Comprehensive Cancer Network, among others, the doctors statement suggests that he is not keeping up with the field of prostate cancer technology. I cannot recommend strongly enough that you seek a second opinion!

Again, congratulations again on notching that additional important low-risk feature!

Take care,

Jim

 
The Following User Says Thank You to IADT3since2000 For This Useful Post:
jwr2992 (02-09-2011)
Old 02-04-2011, 02:43 PM   #13
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Re: A New Club Member

You have heard some excellent points from the forum members. To add to your knowledge base: the chance of dieing of a contained G6 cancer in 15 years is .0003 so don't base your decision on the fear of dieing anytime soon. For low risk PC any and all treatments are similar in effectiveness, and this is due more to the biology of low risk PC than to the effectivess of any particular treatment. The real issue in low risk cancer should be the side affects of the treatment not the effectiveness. The numbers your surgeon quoted are highly optimistic so research the side affects of all treatment options as this is what you will have to live with for the rest of your life. AS has no side affects and the side affects from seeds or external radiation are generally less than those from surgery.
JohnT

 
Old 02-09-2011, 01:40 PM   #14
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Re: A New Club Member

I had an appointment with the radiology oncologist yesterday. He informed me that I had a low risk cancer, T2cNxMx, stage 2, and he recomended surgery due to my young age and good health. Not what I was expecting from the RO. I told him that I was looking at proton therapy at Indiana or Florida. He asked why? I indicated they were close, he told me that if I were considering out of area treatment that I should go to the best ie. Loma Linda, Seattle, MD Anderson, Cleveland Clinic or like. I said ok, I scheduled a consult with MD. He is planning on doing a bone scan here soon. I told him that he had thrown me curve as I was expecting a radiology approach from him and not surgical. I now have two Dr's pushing surgery, I don't want it. My order of preferance was Proton, seeds then surgery. Tomorrow I get to go deal with the Urologist. I believe I am opting for out of area treatment with leaders in the field.

 
Old 02-09-2011, 04:09 PM   #15
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Re: A New Club Member

JWR,
Was the radiologist someone you picked or was it a referral from your urologist or surgeon? Unfortunately the way things sometimes work is that the radiologist gets referrals from urologist for older patients that are not candidates for surgery and this is a large part of his business; the urologist actually is his real customer and not the patient. When surgery is recommended and the patient is sent to the radiologist for a 2nd opinion it is unlikely he would counter the first opinion because he will lose future patient recommendations. Always get a 2nd opinion from a doctor that is unaffilliated with the other doctor.
There have been a number of studies showing that age has no affect, and younger patients have similar results with radiation and brachy as older patients. Long term studies indicate that 10% of all surgical reoccurrances occur after 10 years where about 1% of radiological reoccurrances happen after 6 years. The myth of radiation not being for younger patients is very hard to dispel.
JohnT

 
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