Charlie - At the risk of stating the obvious, if you decide to get surgery, get yourself a really excellent surgeon.  That may be the guy who diagnosed you -- or it may not be.  But there's a lot of evidence that having a very talented and experienced surgeon can impact the outcome.  And, at least for many people, a really great surgeon does not cost any more than an OK one or a crappy one.  If you mention where you are located, some people here would probably have some thoughts.  (I guess the same is true with radiation or any other treatment -- including Active Survailance -- get the best doc you can find/afford to guide/treat you).   Best wishes, Medved

 

Post Edited (medved) : 4/5/2013 2:01:40 PM (GMT-6)

Hi Charlie, I am only 3 months ahead of you with almost identical test results. We all go through the same phases, shock, denial, bargaining, grieving, acceptance. Educating yourself as much as possible will help you get to the last stage much quicker. The good news is, to quote my urological oncolagist, Gleason 6 with small mass and PSA under 10 is low risk. He explained I could have any treatment I wanted but to consider Active Surveillance as a viable option. It all depends on what you can live with. For me, the relatively high risk of side affects associated with all treatments was enough to convince me to wait. Will be seeing doctor on a quarterly basis with blood tests in hand. Next appointment is in 4 weeks.

Hi John, and I too will welcome you. 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 you have time - time to learn about PCa and the various treatment options - so don't panic!  As others have already stated, you'll go through the various emotional stages of shock, disbelief, fear, anxiety, guilt, sadness, grief, depression, anger, and more. Each person may have some or all of these feelings, and each will handle them in a different way.

BTW the last two sentences are from the American Cancer Society's "The emotional impact of a cancer diagnosis" - here's the link:

http://www.cancer.org/treatment/treatmentsandsideeffects/emotionalsideeffects/copingwithcancerineverydaylife/a-message-of-hope-emotional-impact-of-cancer
 

I would also suggest getting a 2nd read on your biopsy slides from a highly accredited/experienced lab such as Bostwick and Epstein.

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 - or AS if that's something you want to consider. 

There are a number of great books out there as well - in addition to Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" I also found Strum and Scholz' "Invasion of the Prostate Snatchers" to be incredibly helpful during that part of my journey.

If you decide on going down the treatment path 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.  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.  You mentioned you are currently in the "get it out of me" phase - I was there at an early point in my journey and I would wager that most of the guys out here went through that as well.  Some stay in that zone and others don't - again it's all about how we feel individually. 

 
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 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.

My Urologist suggested robotic RP. I'm very concerned about side effects though. Again, I want to do whatever will get me the best outcome.
Charlie,
That is precisely how I felt. It is also why I chose Watchful Waiting (that's what it was called then). I was able to do this for nearly two years, but my PSA continued to rise, and a mapping biopsy showed that I had 'progressed' to a significant cancer and needed treatment. I chose LDR brachy for exactly the reasons that you stated. I wanted to be fixed, and I wanted to lower the risk of side effects. I could not be happier with my choice. I wish you the very best.
Be aware that you will have to shop around for the services that you want. My uro also recommended robotic RP: surgery is what he did. I wanted no part of it, and had to break away from him to get the treatment that I wanted. That can be a little scary, but I am ever grateful that I did it. If you said where you are from, I missed it. My treatment was done in WVA.

Hey All,

What a difference a day makes! Still grieving, obviously, but after much prayer, thought, and your helpful and encouraging comments, I have a better perspective.

I'm going to dig into the Walsh book and prepare for my doctor appointments. I'll keep you posted. Praying for all and Donaldj. Big day for him on Monday.

Take care,

John

John, welcome to HW but sorry you have to be here.  As several others have suggested, you barely have cancer and that is the good news.  You likely have the time to get yourself educated, get multiple opinions and then make a sound decision.  Don't let yourself get rushed into anything...if you choose treatment you ge one chance and want to get it right.

I absolutely support the opinion to get a second reading of your biopsy slides by an experienced PCa pathologist.  Reading such slides takes real expertise.  One of the best is Bostwick Labs.  Beyond just a re-reading, you might also consider asking them to do the "Prostavision" panel on the tissues.  This is a fairly new process that provides a molecular analysis of prostate cancer aggressiveness and long term prognosis.  This test was not available when I went through this five years ago but I certainly would have done it if it was.  I don't know if this is covered by your insurance but the direct cost to you would be around $1300 -- I know this because my slides were originally read by Bostwick and I recently inquired (out of curiosity) about this.

There is a high likilihood that any of the mainstream treatments will cure you.  Because of your age, some of the more conservative AS programs would not consider you to be a good AS candidate.  But, if you choose treatment, I would suggest that you focus on the SE's and future quality of your life.  Brachytherapy and surgery have essentially the same cure rate but brachy gives you a considerably better chance of living without continence or ED issues.  (If you want a long-winded first person brachytherapy story, feel free to copy and paste the link at the end of my signature).

In additional to Walsh's book, I would also recommend "Invasion of the Prostate Snatchers" by Scholz that will provide you with some additional perspective.

Good luck and please keep us informed and you travel this journey.

Jim