Doc's Appointment 1/23/08

Could you please advise on questions to ask Urologists at my husband's consultation appointment. 63 year old male, PSA 6 months ago 7.5, two weeks ago 10.5, biopsy found cancer in one core.  Treatment, location of cancer, etc.  What do we need to ask and know ?

Thank you!!!!

Aspects which might influence your treatment options and choice:

GLEASON SCORE or grade is usually a number between 6 and 9 which indicates how agressive the cancer is: with recent screening, most men are now diagnosed with low risk Gleason 6 cancers which is the best score, while grade 8 & 9 indicates agressive high risk PC.

PRINT OUT OF REPORT will also provide other important details like the volume of cancer. Your volume is low with only one positive core. Theis  is also indicated by the % of cancer found in each positive core. 

Biopsy readings are subjective, so it can be worth obtaining a 2nd reading of the slides  and for  any future biopsy, as your decisions are being based largely on the reading.

SIZE OF PROSTATE is worth knowing.  Different things in addition to PC can effect PSA readings,  including infection/inflamation and prostate size which could be influencing the numbers. Sometimes there's an unexplained number:  a further PSA test will confirm a trend with the recent jump.

Putting all this together will determine your treatment options and how agressive your treatment should be,  but in any event you should take some time to fully consider your options.

Choice of doctor is the most important aspect, regardless of which treatment you choose.

Many urologists will not necessarily present you with an objective outline of your alternatives. Most surgeons prefer surgery, with is often not the only alternative.

You could also obtain the opinion of a medical oncologist who is expert in PC.who can provide an objective view and help in the decision making. Often there are several treatment choices which can be equally effective.

It's difficult to logically compare the prognosis figures for various treatments, because equipment and techniques have improved considerably and top doctors will provide better results than indicated in the average figures often quoted. 

There's plenty of information on treatment choices online and published, with several good books available on the subject, depending on which treatments are being considered.

Willa: were you here for something else related several months ago?...just checking...based on what you indicate above, probably your caregiver may advise injected isotope "seeds" primarily because your husband is not in the high teens, %age wise, psa,...seems like a slow progression and only 1 core positive, etc...gleason is important because it indicates the ability of the "bad" cells to hide in the "good" cells....based on a lot of research, you'll never exactly know where you stand until the lymph nodes are removed and the prostate also....its a real crap shoot most of the time to leave the positive prostate in the cavity....but that's a tuff personal decision....for me, about in the same condition as your husband, a little worse on numbers, I had it all taken out a year ago...so far so good, knock on wood...sex life is different but I have a lot of fun/entertaining women friends....and thanks to the VA great network of contract university Dr's & facilities, I get the best care...