Newly Diagnosed, Opinions Welcomed

I was recently diagnosed with Prostate Cancer.  I am 51 years old, had a psa of only 3.5 and have a Gleeson score of 6 (3+3).

My urologist is certain the cancer is contained and recommends surgery for prostate removal.  He's very experienced, and was good enough to find this at the very early stages, even though my PSA did not raise that many eyebrows.

I am hoping that others in my situation might give me some ideas as to what I can expect with incontenance (no problems now) and impotence (no problems now).

Thanks in advance.

Without knowing your full details some general comments on your post;

With recent extensive screening, many men are diagnosed at a very early stage, for example T1c G6.

Most Urologists do (recommend surgery)

Is your question about  what to expect if you have surgery?  If so, there is a huge difference in side effects following surgery, main variables being PC stage and  skill of the surgeon. Many men experience incontence and impotence problems in the short term, but with a top doctor, side effects usually reduce long term.

Some of your options inculde  surgery or  radiation (which are equally effective) proton treatment, and watchful waiting.

You might be interested in some further information:

www.protonbob.com  (a site of people who have used proton treatment)

www.urology.jhu.edu/newsletter  (Johns Hoopkins Winter 2003 newsletter has an article on "insignificant cancers)

Dr Lee Nelson's book on PC is very comprehensive and covers lifestyle, selecting your doctor, stage, treatment choices etc.

If you are considering agressive treatiment based  on A biopsy result, it could be worthwhile obtining a 2nd reading of your slides, as biopsy readings are subjective.

John 

 

 

 

Based on your young age, you need treatment and are not a candidate for watchful waiting.  Also warn any male members of your family that they are also at high risk and need to be checked.

  In the old days, surgery gave the highest PSA free survival.  Now XRT , seeds etc are equal and have a better benefit to risk ratio.  Very little or no incontinence and much less sexual disfunction.  I recommend External beam, especially if you work since treatment can be scheduled around your schedule.  Also recent studies show if the tumor comes back , you have better second chance to cure it if local only.  Then seeds can be used relatively safely for salvage. Proton beam is investigational, but some points need to be addressed.  Like seeds any advantage is with dose to normal tissue.  This used to be a big deal, but now is not so much with IMRT etc.  Protons are not more effective than Xrays at killing tumor cells and if you have to treat a margin or lymphnodes you lose any advantage.

I too am 51 and recently diagnosed with PC.  I could not stand the idea of diapers or impotence.  Please check out RCOG.com and go to rcogpatients.com and at least review this information before making a final decision.  This is where I am currently at and getting cured by their treatments.

I would agree with John.  Urologists recommend surgery.  Its what they do.  When it comes to side effects from RP, there is no one answer because the chance of urinary incontinence and sexual impotency varies tremendously with the skill, training and experience of the urologist performing the surgery. Complication rates  generally show urinary incontinence rates of around 5% and preservation of sexual function in 49-76% of men, depending on their age, if men have normal sexual function beforehand and have sparing of both sex nerves.  On the other hand, a radical prostatectomy performed by the average urologist who typically performs one or two dozen surgeries per year may result in loss of sex function in 90% of men and urinary incontinence in 32% or more of men.

Thank you very much for your response.  It's a very interesting site and has me re-thinking my position.

I had pretty much decided on surgery (I have a very good experienced surgeon) but the risks of incontinence and impotence make me very nervous.

I wish you the best in your recovery.

 

On 2/26/2007 Johnw100 wrote:

Without knowing your full details some general comments on your post;

With recent extensive screening, many men are diagnosed at a very early stage, for example T1c G6.

Most Urologists do (recommend surgery)

Is your question about  what to expect if you have surgery?  If so, there is a huge difference in side effects following surgery, main variables being PC stage and  skill of the surgeon. Many men experience incontence and impotence problems in the short term, but with a top doctor, side effects usually reduce long term.

Some of your options inculde  surgery or  radiation (which are equally effective) proton treatment, and watchful waiting.

You might be interested in some further information:

www.protonbob.com  (a site of people who have used proton treatment)

www.urology.jhu.edu/newsletter  (Johns Hoopkins Winter 2003 newsletter has an article on "insignificant cancers)

Dr Lee Nelson's book on PC is very comprehensive and covers lifestyle, selecting your doctor, stage, treatment choices etc.

If you are considering agressive treatiment based  on A biopsy result, it could be worthwhile obtining a 2nd reading of your slides, as biopsy readings are subjective.

John 

 

 

 

Thanks John.

I must admit that when I first was diagnosed, I felt a sense of urgency.  I don't feel that any longer and am re-thinking my decision.  I still trust my urologist.  It was because of him that the cancer was found so early, and he's very experienced.

 So, hypothetical question here: if a urologist is a good surgeon, would you think that surgery and radiation treatments are toss ups?

 

On 2/26/2007 Oncrx wrote:

I would agree with John.  Urologists recommend surgery.  Its what they do.  When it comes to side effects from RP, there is no one answer because the chance of urinary incontinence and sexual impotency varies tremendously with the skill, training and experience of the urologist performing the surgery. Complication rates  generally show urinary incontinence rates of around 5% and preservation of sexual function in 49-76% of men, depending on their age, if men have normal sexual function beforehand and have sparing of both sex nerves.  On the other hand, a radical prostatectomy performed by the average urologist who typically performs one or two dozen surgeries per year may result in loss of sex function in 90% of men and urinary incontinence in 32% or more of men.

Thank you very much for your opinion.

I am amazed at the different percentages I am hearing.  My urologist, of course, was much lower.  And sites on the internet bounce all over the place.

 

On 2/26/2007 Witchdoctor wrote:

Based on your young age, you need treatment and are not a candidate for watchful waiting.  Also warn any male members of your family that they are also at high risk and need to be checked.

  In the old days, surgery gave the highest PSA free survival.  Now XRT , seeds etc are equal and have a better benefit to risk ratio.  Very little or no incontinence and much less sexual disfunction.  I recommend External beam, especially if you work since treatment can be scheduled around your schedule.  Also recent studies show if the tumor comes back , you have better second chance to cure it if local only.  Then seeds can be used relatively safely for salvage. Proton beam is investigational, but some points need to be addressed.  Like seeds any advantage is with dose to normal tissue.  This used to be a big deal, but now is not so much with IMRT etc.  Protons are not more effective than Xrays at killing tumor cells and if you have to treat a margin or lymphnodes you lose any advantage.

Excellent advice, thank you.  Would you mind sharing with me what field of medicine you are in?

Actually, watchful waiting is an option based on your low PSA , low Gleason and localized disease.  You could go every 3 months or so to recheck the PSA and then take action if you see consecutive increases.  Your other options, according to treatment guidlines, are RT or RP.