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Pathology Report, weighing my options

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Prostate Cancer
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Posted 12/2/2014 3:37 PM (GMT -5)
Met with URO today and went over my pathology report and options.

4 of 10 cores positive, involving both sides: T2c. A 5th core was atypical. 1 core 5%, 1 core 20%, two cores 30%, all 3+3 = 6

We both agreed that AS is probably not a good choice, but he also stressed that I don't need to rush into any decision either. In spite of the comedy of errors that my brother has been through (and it does weigh heavily on my thinking, brother,) I am leaning toward surgery. The URO is recommending RALP. There are only five surgeons in my area that do that. He is not one of them. Of the five that do RALP, he only recommends two of them. I've scheduled a meeting with one of those two to discuss it further.

We also discussed EBR, and BT, as primary treatment options. BT is my second choice, right now.

Thoughts?
Posted 12/2/2014 3:47 PM (GMT -5)
Have you spoken to an RO yet? You need to at least talk to one before deciding.

Surgery is a good option and likely would put you in the 'curable' zone. BT would do the same - possibly with a shorter recovery time and SE.

It's a tough call - all the surgery guys will now post how good surgery is (it comes with a free pathology report that you don't get with radiation) and how scary radiation is followed by all the RT guys saying that's not true and you get fewer ED and incontinent issues with brachy.

Bottom line, your choice and not a lot of clear science to justify one over the other for you.
Andrew
Posted 12/2/2014 4:03 PM (GMT -5)
Good point. I will make an appointment to talk to RO as well.
Posted 12/2/2014 4:13 PM (GMT -5)
Why is AS off the table? While I don't know the specific parameters to be considered for AS, I would have presumed you would qualify. Of course, if that's something you personally don't want to do that's another matter and a very personal choice.

I do agree that you have lots of time to make a decision. And basically whatever treatment option you go for should cure you I think you mainly need to focus on which set of SEs and logistics that you can best handle.

Good luck in making your decision!
Posted 12/2/2014 4:48 PM (GMT -5)
While my score is 3+3, and AS is an option, the fact that it is on all parts of my prostate, and both sides, and that my brother went from a 6 to a 7 while waiting, is an indication that this will grow, if given the chance. So while AS is not off the table, it's the least desirable option in my view. I felt this way even before talking to the URO, and he was relieved to hear that I didn't want to consider it.

I am certainly worried about SE of either treatment, but long term, surgery is likely the best option for me. My hope is that, having caught it early, surgery will be the only treatment necessary, but if it's not, I have a couple of options to follow.
Posted 12/2/2014 5:21 PM (GMT -5)
I wanted to correct some mistaken notions you seem to have about AS. There is no AS protocol I'm aware of that takes AS off the table for being in both lobes. Your brother's disease is not yours - heredity increases risk of occurrence, but I haven't seen anything that shows it increases risk of progression. However, the whole point of AS is to wait for progression from GS 6 to GS 4+3 before seeking treatment, as there is almost no risk in doing so (based on Klotz's monitoring for up to 15 years so far). At the very least, it gives you extra time of symptom-free living. Most protocols watch one closely enough so that if there is progression, you will have plenty of time to act.

Just as for any other treatment, it behooves you to talk to experts in the field before making your decision.
Posted 12/2/2014 5:47 PM (GMT -5)
Forgive me if I gave the impression that AS is NOT an option. It certainly is, but both the URO and I agree that it is not a very good option.
Posted 12/2/2014 6:41 PM (GMT -5)
I was also 47 with a Clinical T2C, 8 out 12 cores. I did the surgery and mine ended up being a pT3a. Didn't go anywhere and psa undetctable for 3 1/2 years. Just remember T2C is one away from possibly getting out, so I wouldn't wait.
Posted 12/2/2014 6:44 PM (GMT -5)
IMHO AS has been part of the reason I have had further complications and sever SE since my RALP...and yes I am Ichabod's brother! Now finishing my SRT, six more treatments to go, still as inconetnent as I was 9 months ago, I don't wish this on anyone especially my brother. I have spoke to him in depth, and he is well aware of what has transpired with me and the risks rewards of each. I want him to lean towards options that best fit him and his situation...I also don't want him to be like me 13 months out from RALP hating life!!! It sucks to have to go through this for anyone as we all know...but to see your younger brother now face the same crap really sucks! I was not the first male in our family to be diagnosed nor treated for PCa but I sure hope that my brother is the last! Love you man here for you for what ever you need/decide...but your need to get your own depends I am using mine!
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