Choosing A Treatment

I was diagnosed with early stage prostate cancer a month ago.I am 70 yrs. old and in good health. Biopsy results: Stage T1c. Gleason 6. Volume 2% in one core. PSA 4.3.

For treatment, I am trying to choose between robotic laparoscopic surgery or IMRT. Main concerns of course are potency, continence and other long term side effects. If any one has input,I would definitely appreciate it.

Ray.

All treatments have improved greatly, and there are so many variables that it's not  logically possible to compare the  treatment outcomes. Several options can provide similar results so it often comes down to personal preference and consideration of the side effects as  you mentioned.

The potential for bowel side issues can be a considerationwith with radiation, which would  be more of an issue  for anyone with previous bowel problems.

The main variable and most important consideration is selection of the best doctor available, who will have a big influence on the outcome. Robotic techniques are being improved, so I'd want a top surgeon with lots of Robotic experience and also extensive experience with nerve sparing open surgery, as it occasionally becomes  necessary for the surgeon to revert to open surgery.

Only 2% of one core is a tiny amount of cancer. Biopsy reading is subjective, and what lools like cancer to one person can appear normal to another. A 2nd reading should be obtained from an expert pathologis if you havn't already done so.

With recent more extensive screening, most men are now diagnosed with early stage G6 cancers, in some cases with very small cancers, which raises the dilemma of over-diagnosis and over-treatment.

Active surveillance is usually discussed for men who meet certain criteria: there are a number of publications on it, including several by John Hopkins on Insignificant Cancer. www.urology.jhu.edu/newsletter  (winter 2003 newsletter).

I agree with JohnW completely.

Biopsy results are subjective...........and, the opposite of what John said can also be true.........there can be more cancer there than what has showed up in the minute bits they have analyzed from the biopsy. That was my case.

Second and third opinions are a great idea, and as John has said.........get a top Doctor.....one who has done a lot of operations.

Best of luck...............Stan.

On 3/22/2008 Johnw100 wrote:

All treatments have improved greatly, and there are so many variables that it's not  logically possible to compare the  treatment outcomes. Several options can provide similar results so it often comes down to personal preference and consideration of the side effects as  you mentioned.

The potential for bowel side issues can be a considerationwith with radiation, which would  be more of an issue  for anyone with previous bowel problems.

The main variable and most important consideration is selection of the best doctor available, who will have a big influence on the outcome. Robotic techniques are being improved, so I'd want a top surgeon with lots of Robotic experience and also extensive experience with nerve sparing open surgery, as it occasionally becomes  necessary for the surgeon to revert to open surgery.

Only 2% of one core is a tiny amount of cancer. Biopsy reading is subjective, and what lools like cancer to one person can appear normal to another. A 2nd reading should be obtained from an expert pathologis if you havn't already done so.

With recent more extensive screening, most men are now diagnosed with early stage G6 cancers, in some cases with very small cancers, which raises the dilemma of over-diagnosis and over-treatment.

Active surveillance is usually discussed for men who meet certain criteria: there are a number of publications on it, including several by John Hopkins on Insignificant Cancer. www.urology.jhu.edu/newsletter  (winter 2003 newsletter).

John. Thank you so much for your information- especially in reference to getting a 2nd reading of the biopsy results.I had not thought about that, but I will get a 2nd reading now.   Could you possibly share with me some of your cancer data- particularly your treatment choice, outcomes and your age. Thanks again.  Ray.

I am 80 yrs old in good health. Had aggressive localized prostate cancer. I chose Tomotherapy at Cancer Treatment Centers of America. No "bowel" problems. Tomotherapy is very precise and little side-effects. Certainly I would never consider surgery when a non-invasive treatment is available. One exception might be to watch and wait until Hi-Fu is available.

George

Ray,

I was diagnosed in 2004 with T1C G6 Prostate Cancer in 1 of 10 samples and high grade PIN, at  age 60.

Subsequently I have undertaken lifestyle changes to activity, diet, nutrition, supplements etc,  and no agressive treatments undertaken  with what could be described as  active surveillance.

In 2006, my 12 sample biopsy was all clear with no PIN. My PSA has remainded constant in the meantime.

I'm fortunate in that treatment options and techniques have improved greatly in recent years, and I know a lot more now than I did in 2004.

Consequently, should my situation  change and if there is a need for me to reconsider mainstream treatment options in the future, my choice of treatment and doctor will provide a vastly better outcome than would  otherwise have been the case. 

Best wishes

Ray:

Your concern about side effects is warranted.  Your numbers indicate you likely have indolent cancer, one that need not be treated directly at this time. At your age, the chance of side effects from surgery are real and those of radiation, though less at the time of treatment, usually accumulate as time passes. Active surveillance, which your stated numbers clearly qualify you for, have no direct side effects, other than anxiety, and men on this site as well as others will tell you that psa anxiety persists REGARDLESS of the treatment chosen. There is certainly no reason to choose a treatment immediately. Follow your numbers, keep a close watch on psa, have regular DRE, visit with your local support group (valuable!), seek another medical opinion, have your slides from the biopsy sent for another opinion if you wish, and read, read, read. Once you are comfortable pursuing your path you will have had enough time to be confident of your choice. You will not die from this disease. 

Best of Health 

Hi John W,

 I am in a similar situation, nearing two years from diagnosis, and would like to know at what level your PSA has remained constant. 

Thanks,

Jeff

I was diagnosed with prostate cancer in Sept, 2007. From my research I realized that HIFU is the best method. There are two HIFU system; one called Albatherm and the other called Sonablate. I initially chose the Albatherm only to later change to the Sonablate because my prostate had to be reduce to 40cc or less for the Albatherm. I could only get it reduced to 43.5cc over a 5 month period so I switched to Sonablate HIFU which can handle prostates as large as 50cc and has better monitoring of the prostate during the procedure. The Albatherm takes an image of the prostate at the beginning of the procedure and works from that image whereas the Sonablate continually takes images of the prostate during the entire procedure. The 3-D imaging can detect missed areas and then the urologist can redo the missed areas within the target block. As it turns out there are several Sonablate clinics in the US which are conducting trials and there are 4 Sonablate clinics in Canada where it is an approved treatment for prostate cancer. There is also at least one in Mexico. From my point of view the Sonablate HIFU is the best procedure with incontinence results of 0.6% and ED of 20% but I believe this number is too high as the systems have greatly improved in identifying and protecting the nerve bundles and surrounding blood vessels. I had my Sonablate HIFU procedure done in Winnipeg on March 29th, 2008. Here is the website for Sonablate HIFU; http://www.hifucarecenter.com/