Help with dx and treatment options

My husband and I met with Urologist yesterday and he was diagnosed with prostate cancer. Here is the information from the biopsy report in condensed form.

Age 61

PSA 10.44 3/11 up from 7.5 1/11

DRE Isolated nodule

T2a left mid

10 of 12 cores positive for cancer

3(4+3), 5(3+4), 2(3+3)

percents of cancer found in each core(25,26,32,36,40,46,50,57,67,89)

Gleason score 3+4=7

Perineural invasion found in 5 samples High grade PIN found in 1 sample

Bone and CT scan no evidence of spread

Okay, uro said there was a large amount of cancer found and because of that he classifies his cancer as highly agressive instead of the moderate which the gleason 7 reflects. He also said the cancer had only been there less than 2 years as he performed a TURP on my husband in Sept 2009 in which he removed 50% to 2/3 of prostate tissue all of which came back negative for cancer.What happened to the 10-15 years that it takes for pca to grow?

He said my husband had only 2 options for treatment. The first is the da vinci robotic surgery where he would remove entire prostate along with 3-20 lymph nodes and no nerve sparing promised. He said this was a 1 night hospital stay and 7 days home with catheter.

The second option is external beam radiation (5 days a week for 8 weeks) followed by 3 years of hormone shots.

He recommends surgery as if that fails then they can still do radiation but not vice versa.

He also said there is a 50% chance that the cancer has spread from the prostate .

He said whatever decision is made that my husband needs to make it immediately and he would do surgery right away.

I thought they would not do surgery that soon and protocol was normally 6-8 weeks post biopsy.

We have a Vegas vacation booked for mid July and the uro said he cant wait that long but if he absolutely had to he would give him a hormone shot before vacation and surgery upon return.

Does anyone have similar stats to my husbands and chose one of the treatments over the other? I would appreciate any and all responses. And do you feel an urgency in this as the uro has expressed to us.

Thanks in advance!

Thank you Tudpock. We live in Raleigh, NC and his urologist said that he wasn't eligible for the seeds due to the amount of cancer found. His specialty is the robotic surgery and says he has performed more of these than anyone in the area. He has excellent credentials but I agree that we should meet with an oncologist as well.

Packfan, you are lucky enough to have the Duke Cancer Institute in your backyard.  My understanding is that the Duke Prostate Center (within the DCI) can offer you a multi-dilciplinary approach including oncologists who specialize in PCa.  That would seem to be a good option.

Tudpock (Jim)

Check out High Dose Radiation brachytherapy.   This is where the radiation seed is not left in the body.   It is very effective in locally advanced situations.   I used it along with IMRT (for the gland, margins and lymph nodes) and HT (Eligard and Jalyn) to weaken the PCa and starve it if it has spread but can't be found.   My numbers are similar to yours, but PSA was much higher.

Best info is at www.cetmc.com.   Dr. Jrffrey Demanes at UCLA is the pioneer of HDR and has 15 year numbers you can see.   I had mine done is Atlanta.   I will be happy to ask my uro and rad-oncs for people in your area that perform HDR.

Packfan,
I would certaintly get other opinions. The PC seems to be fast growing so I would not wait too long, but a month or two shouldn't matter. Since he has had a Turp, radiation may cause additional problems, so you need to be very careful and ask a lot of questions about this. He can also take Casodex in pill form and this will stop any growth until you make a decision.
JohnT

Keep your spirits up packfan, in an odd way the fact that it has been arguably fairly well " confimed " to have been there only 2 years, via the Turp, to me is a positive. Aggressive yes but short term in PCA world, is a positive,IMO. HAs He had bone scan to rule out discernible mets? He is highly treatable , this is not false hope, this is hope for breakfast and dinner. How is his health otherwise, prior to diagnosis? I,m not sure what to reccomend. I like Surgery in a lot of cases due to post op pathology availability. The fact your doc will dissect lymph nodes is a good thing. rcroller is has/had surgery today 3.5 weeks post 12 core biopsy, which is less damaging to prostate. The reccomendat is 6-8weeks , all things being equal, but things never are. A good surgeon can do a successful op close to biopsy, but it is more difficult and would think could cause complications, not fatal, just cause other things to deal with, maybe. Its a cost/benefit analysis, like so many things. Cost ,not in a financial sense. Thing that concerns me is open surgery has tactile feel, which could come in handy in complication from quick surgery How quick is quick here BTW? Of couse he could and would switch to open if need be. I think he is a smart man and for sure has your back on this but 2nd opinion from the facilities you have there would help and you could still keep your sugeon