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Bartb49 · 09-26-2012, 05:49 PM

Hello, I was just diagnosed with prostate cancer and I was looking for a good place to get some more information. I took a PSA test a month or so ago and it came back at 7.5. I am 49 years old. A biopsy was ordered by my physician and my results came back as cancer in one of twelve cores, 10%. My gleason is 3+3=6. I have went over my options with my physician and it sounds like to me that I can either do active surveillance or surgery. The surgery scares me because of the possible side effects. My young age is a concern and I am not sure what I should do. Any help would be appreciated.

Thank you,

Bart
Age 49
gleason 3+3=6
1 of 12 cores, 10% invasion of the core

Tall Allen · 09-27-2012, 01:20 AM

Hi Bart,

I'm sorry to welcome you to the club, but as Dx's go, yours ain't too bad. I'd recommend that your first order of business be to get a second reading on your biopsy. Gleason grading is almost an art and there are a few labs that specialize in it, like Bostwick or Epstein. You don't wan't to overreact to something that isn't really there or vice versa.

The last thing you want to do is jump into a hasty decision now while you are in "cancer panic" mode. Know that you have plenty of time to make a decision, and it will be up to you to learn about the alternatives, their curative power and their side effects. Doctors will almost always recommend whatever they specialize in -- surgeons recommend surgery, brachytherapists recommend brachy, etc.

Assuming it's confirmed, and that you have an insignificant amount of low grade cancer that may never become a problem, Active Surveillance is certainly a great choice. You have many years to live, so why not live them symptom-free for as long as you can, perhaps for your entire life? You can always treat later if it progresses, and by surveying it actively, you'll know when that is.

Because you have so little involvement, focal therapy is also a possibility for you. That means they image and treat just the cancer and leave the rest of the gland intact. Because PC is usually multifocal, it may not cure you, but may buy you more time on AS. Imaging techniques are improving and there are a few experts at certain kinds.

If you eventually decide to pursue radical (whole gland) therapy, all of the following have 95+% cure rates in the hands of the best practitioners for low risk disease like yours:

Surgery (robotic, lap or open)
SBRT (CyberKnife)
HDR brachytherapy (temporary implants)
LDR brachytherapy (permanent seeds)

With cure rates that high, you can be reasonably assured that the problem will be fixed once and for all. While their cure rates are equivalent, their typical side effect profiles are different, especially surgery. I won't overload you with details about them now, and some may not be available to you where you live. Just know that there are many more alternatives than your urologist seems to be familiar with, and you have time to investigate and interview several doctors. I talked to 5 specialists over 6 months before I made up my mind.

Please feel free to ask questions whenever you are ready.

- Allen

jerseyguy · 09-27-2012, 05:01 AM

Bart, I couldn't say it any better than what Tall Allen said. I would like to emphasize to get a second opinion on your biopsy results and read as much as you can on PCa. Over time you will be able to make the right treatment decision for yourself. Our stats are similar, I saw 51 when diagnosed with 1 core out of 12, Gleason 6, PSA 3.9 back in February. Its been 7 months and I am still learning. I have decided to follow AS just to see how this progresses. Based on my research age is becoming less of a concern when following AS. Don't make any decisions based on fear. I wish you the best.

Baptista · 09-27-2012, 10:37 AM

Bart,

You got a low risk case diagnosis. Surgery or radiation may provide you cure but at a cost of quality of living.
Low grade cancer (Gleason 3) can be sort of indolent and never border or threaten one's life.
Active surveillance is a good alternative regimen to similar cases. You need to set a modality with an expert and just be attentive with tests periodically.
Young patients have a lot to "lose" with the side effects from radical treatments.
Try to be informed about everything related to prostate cancer reading books and searching in the net.
Type "Prostate cancer diagnosis and treatments and side effects"

Get second opinions on everything.

Wishing you luck along your journey.

Baptista

Bartb49 · 09-27-2012, 11:24 AM

Thank you guys for your responses. It helps to hear from people with similar circumstances and from people with knowledge. I am being followed at University of Iowa Hospitals and Clinics. In the state of Iowa that is the place people go for 2nd opinions and to see specialists. In fact, I work here. Do you guys suggest I go somewhere else like Mayo to see what they say?

Again, thanks you for your responses. I wish you all the best.

Tall Allen · 09-27-2012, 11:46 AM

For your second opinion on the biopsy, just tell your urologist to send the slides to one of the specialist labs I mentioned -- there are probably a few other choices -- those are the ones I'm familiar with.

For second opinions on treatments, it behooves you to find specialists in those treatments. It can make a big difference. For example, the LDR brachy specialists in Seattle get far superior results compared to most others. There are only a few doctors in the US - Drs Lee, Bahn and Ukimura come to mind - that are expert in using color doppler ultrasound for focal therapy. It may be difficult to find an expert HDR monotherapy specialist in Iowa -- the closest I know of would be at William Beaumont Hospital in Michigan. You have to ask Accuray or find on their website the closest CyberKnife center. Surgeons should have done at least 1000 of that particular kind of surgery and have clear margin rates in the 10-15% range. You can reasonably expect excellent care at any NCCN hospital. Many doctors will give you a phone consultation. Many of the treatments I mentioned only take a day to a week. The other consideration is what your insurance will cover.

AS programs are becoming prevalent and you can get in on one of them almost anywhere.

- Allen

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