Biopsy results

James, what I was told was that the two surgery modes have similar outcomes, with RALP having less blood loss, less pain, and overall faster recovery.

The key is finding the best surgeon and team you can find. The single best indicator of a successful outcome is the skill and experience of the surgeon. Go big or go home might be the idea to remember.

You do, however, have time to evaluate all your options. I would encourage you to talk to a Radiation oncologist and let them evaluate you for RT. Surgeons cut, and radiation guys radiate. Always remember that little detail.

Hi James, and welcome to our little corner of the world. You have come to a good place with immeasurable help and knowledge from those that have "been there, done that" with respect to being told we have PCa, learning about the beast, deciding on a treatment path and moving on. Please keep in mind that with your statistics while I also believe you need treatment, you do have time - time to learn about PCa and the various treatment options - so don't panic or rush!

I would suggest getting a 2nd read on your biopsy slides. Labs such as Bostwick and Epstein are two of the best and a 2nd opinion is usually a good thing to add to your decision making tree.

Along with forums such as this where you can learn from people that have and are going through what you are, do as much internet research as you can. When I was at your point in my journey I encountered the "paralysis by analysis" syndrome as I was spending several hours a day doing all of the research and reading as much as I could - but that's o.k. as it will put you in a better place in terms of deciding your choice of treatment.

You will also want to talk to and if possible meet with as many of the medical experts in the different treatment approaches as you can. As Halbert already correctly pointed out - each will profess their own approach as the best - so get opinions from the different disciplines. When you do, be sure to ask for their specific outcomes post treatment - % regression free, continency (and have them define what "continent" means - to you and I it means NO issues, while others may qualify that with "only one pad per day" or "only when straining") - same goes with ED. They all have these statistics and if they say they don't or are unwilling to share that would be a cause of concern for me.

At my young age (BTW, how old are you James?) and excellent health, and with no symptoms or issues - while curing the cancer was / is my top priority, at the same time preserving my quality of life ran a very close 2nd. Be aware of this by doing your research and getting these statistics from the practitioners/treatment modalities you may be considering going with. You only get one shot at this - one of the most important decisions we're likely to make in our lives.

As part of my journey to learn about the various treatment options I downloaded, purchased, and copied a number of studies and results that I would also be happy to share with you, so again if you are interested shoot an e-mail my way and I'll reply right away.

We are all out here to help - my very best wishes to you in this journey.

James,

My biopsy report was similar to yours. I had G7(3+4), and 5 out of 12 cores positive. My percentages were a lot higher than yours; but my PSA was only 5.16. I had the RALP. I liked the shorter recovery time. Not having had the open, I don't know about less pain; but I had little to no pain with the RALP.

One advantage to surgery that I liked; you get a full pathology report of the prostate. Since they remove it, they can find out just exactly what you had. The biopsy is known to miss some of the tumors. In my case, I found out that I had Gleason 8 instead of 7. That bumped me up into high-risk cancer, and made my urologist more careful about checking my PSA, post surgery. Because of that, I found out last month that my PSA has now become detectable, after almost 3 years of being in the Zero Club. With a G7(3+4), he might not have had me check every 3 months for the first year, and every 4 months since. This way, we can jump on this right away.

I won't kid you about side-effects. I still have some minor incontinence, and full ED. I did have some ED before surgery, caused by my having Type II diabetes. And they will tell you that whatever function you had before surgery, expect it to be less after. In my case, it completely killed it. But I look at the big picture. I was willing to give that up for the knowledge of what I was dealing with, definitively. Surgery gives you that. You will know exactly what you are dealing with.

Some guys are okay with not knowing exactly what they have. Radiation or brachy is good for them. The side-effects are generally better in the short-term (although long-term, radiation seems to approach the same side-effects as surgery - still up for debate).

Whichever route you choose, just be aware that your life has changed forever. You are now a member of the 'C'-club. Once in, you never really get out. The important thing, for you, is that YOU settle in YOUR mind what YOU want. Get as much information as you can. This forum is a great place to find that info. Get Walsh's book. Another good book is "Winning the Battle Against Prostate Cancer" by Gerald Chodak. Knowledge is your friend right now. And don't let anyone rush you into a decision. The good thing about this Beast is that it is slow growing. You have time to make an informed decision. But once you make that decision, don't look back; or try to second guess yourself. We could all play the "What if?" game. Make a decision and go with it.

I hope this helps. Keep asking questions. There are a lot of knowledgeable guys here, who have been where you are now. Don't be afraid to use their knowledge. Keep us informed of what you decide. We all might have different opinions on which is the "best" option to choose; but once someone makes that decision, most guys here will support you in it.

Best of luck!
-Bob

RR, you got great advice above, especially from Yoop, but from all who posted. I can't emphasize enough, the importance of getting a second opinion on the slides.

Welcome, we know you wish you didn't have to be here, so do we, but it is what it is.
Stick around, you'll getvgreatveducation and support

Thank you guys, I'm overwhelmed by all your replies
and I know it takes time to word responses.
I know it took me awhile to post it, perhaps posting it brings it home.

I think a lot more importance has to be given to MRI in targeting Biopsys.
Prof. Elle Barentsz is doing great work in pioneering this
In my case I had 2 previous biopsys in 2008, 2012 both negative.
If my recent biopsy had been done randomly (without MRI aid) then the score would most likely be 3+3 or less.


Halbert, yes RALP sounds much better but it's not covered here by public health cover
I'll find out about RT ..thank you.

Andrew, does Brachy limit the options if follow up is needed.

Yooper, I am 59 (well for another month) in good health other than painfull urination especially if it's 1-2 hours between intervals
I've had 2 inguinal hernia operations and left side causes muscle spasm at times.
Perhaps a silly question but does the urination problems generally get better or worse long term after surgery.
I like that ''paralysis by analysis'' I think I might have done some of that already
with trying to figure out 2 different MRI readings,
1.5T MRI showed three small foci and 3T MRI showed one 5mm foci.
Another issue is the quality of the images on MRI, on my 3T MRI
No b 1400 images or higher were done and DWI was of low quality.
I was lucky that my Urologist found it using general anaesthetic and bending the needle (right mid PZ)
You point that it is ''one of the most important decisions we're likely to make in our lives'' that definitely has made me stop and think.
I would love to receive those reports, I will PM you ..thank you

Hi Almost, thank you for your comments
and reading your Signature brings things back into perspective ..thank you.

Bob, thank you for that information. Urologist is saying not a candidate for Brachy I think it's due to the Perineural invasion.
I will have to find out about radiation ..can it only be done once?
I 'am' a bit of a what if guy but in this case I will do the research and thanks for helping with that.

Jim, I notice you had the Brachytherapy, is it the Perineural invasion that rules out that type of treatment

Pratoman, yep, I had myself convinced from the MRI reports that it was insignificant
but do you know that feeling when you are waiting to see the Urologist and you wonder about little things like why the nurse who always stopped to chat before, doesn't this time
and why the app. date after biopsy was moved to 2 weeks instead of the original 4 weeks.
Yes, it is a great community here ..people who have their own hands full but yet give their time to help others.

Island Time, thank you and a good point.

Sorry ..I did'nt mean to write a book here.
James

RR, this is from the web site of the American Cancer Society:

"Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion doesn’t mean that the cancer has spread, and other factors, such as the Gleason score and amount of cancer in the cores are more important. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor."

To answer your question specifically, perineural invasion does not rule out brachytherapy. Due diligence would suggest that you discuss your case with an experienced brachytherapist to see if you are a good candidate. I would not simply take the word of the urologist who diagnosed you as he may not be well informed about the procedure and/or he may be biased toward surgery since he is likely a surgeon.

Jim

PNI is one reason to do Brachy because it can treat up to 15 mm of the prostate bed where cancer cells could reside from PNI. Surgery treats about 1mm of margin.
I was also told by my surgeon the I wasn't a candidate for Brachy, turns out I was a perfect candidate. Only a trained Brachytherapist can give you a correct answer after a CT scan. The main reasons to disqualify Brachy is due to Pelvic Arch, a prostate over 60mm that cannot be shrunk by Homones, or systemic disease. Strictures and a Turp are also reasons not to have the procedure.

RR, one suggestion I heard, and followed, is to get yourself a big accordion folder and a spiral notebook and take it to all appointments. Put all the paper you get in there, and take notes. Lots of notes. Write down your questions before you go to your appointment.

If she's good at it, have your wife take the notes.

Not necessarily My surgeon told me ahead of time with the main tumor identified on biopsy with ultra sound on the right sound it was his protocol, as the cancer likes to gravitate to the nerve bundles to remove nerve bundles threatened. I was as uninformed as any newbie, so did not balk. If I knew then what I know now I would have done BT. But no shame, he did an excellent job, imo. but probably could have saved the right nerve. I would say especially in open surgery, the surgeons either protocol {verb}it or have an inkling and wait till they can see and feel. Surgeons have gut instincts like everyone else. Yes brachy can "treat" the nerve bundle as well, but that is to be avoided, unless the cancer has invaded{surgeons call} you cant radiate nerve bundles and be nerve sparing. The bundle will be gone. A lot of the answers you are asking now, would be better served by the appointment wit BT specialist. Patients{virtue| goes a long way after a pca diagnosis… as well in life itself Don't shortchange yourself by jumping on the first treatment you here. You in all probability will regret that. I did….but regrets are only for fools….in a purely rhetorical sense.

River - my comment isn't advocating for any one treatment. Just don't take a surgeon's word for something that is an RO's area of expertise. It's possible you're not a brachy candidate, but I'd want to hear there from a brachy specialist.

and sometimes Brachy can be followed up with beam radiation, depending on a lot of factors. Have you been to consult with an RO yet? It might be a good option as the RO can target an area just around the prostate to catch any PC that might be there.

hang in there - it's not easy sorting out all your choices.

Andrew

River Road, to answer your question, I think there are some advantages to BT over surgery, but there are some advantages the other way around as well. Most everyone here has an opinion on it, and probably 80%+ favor the treatment they had. It's a very personal thing and everyone reacts differently to it--you'll need to do some research on your part to see how the differences work best for YOU.

With that caveat, in very general terms brachy can treat a slightly wider area than surgery and many people find that the SEs are less significant. Surgery, on the other hand, tends to appeal to the "let's cut it out crowd" and those that like the clarity of having a final pathology of their prostates. BOTH would be quite likely to cure you.

Also, you should know that there are two types of brachy--low dose radiation (LDR) in which radioactive seeds are implanted in you and high dose radiation (HDR) in which a higher dose of radiation is used but is not permanently left in your body. On the radiation front, one other treatment to consider is SBRT, which uses just a few sessions of high dose radiation (from an external beam, unlike brachytherapy which goes straight to the prostate).

You'll need to be your own advocate in sifting through all the options--most medical professionals only know their own area of expertise in detail. That said, the group here can be valuable in terms of providing guidance on who can help answer your questions.

nomograms gave me 40% chance of escape which are statistically based. I was prostate contained. Urologists throw out opinions, on things that patients ask and they really don't know ….like samples of drugs. There proclivities are usually based on edumacated whims or whether they have indigestion or not. I have very weak knowledge on BT or radiation treatment. KNow nothing about SBRT, except its a relatively new form of radiation. Heck if you fry the prostate and more surrounding areas in a shorter period, sounds good to me.