New prostate diagnosis

john2723 · New User Joined: 25 May 2008 Posts: 1

There may not be a "right" answer to my question. I am searching for opinions about treatment options for my father. He is 67 years old, in great health with the exception of a hip replacement a few years ago. Normal exam (DRE)no prostate nodules and no enlargement, PSA rose from 3.5 spring of 2007 to 5.5 spring 2008 prompting a biopsy. 1 of 12 biopsies positive for prostate CA, Gleason 9. I don't know if it is 5+4 or 4+5. The CA was not in the entire core taken in that one biopsy. His bone scan is negative, His pelvic CT was also negative. He received a shot of Lupron (anti-androgen)from the urologist in Akron,Ohio who did the biopsy and was sent to see the radiation oncologist for evaluation. He then visited another urologist for a second opinion at the Cleveland Clinic who recommended a non nerve sparring radical prostatectomy. This urologist thinks there is a better survival rate/ better outcomes with surgery than with the radiation. Although if surgery is done, depending on the pathology report and true stage, he then may need radiaton in the future. My dad is leaning toward the surgery and understands all of the side effects. He may seek a third opinion, the "tie breaker". I have not yet asked the urologist his history of surgical outcomes in this situation. Radiation oncology gave a 30% risk of recurrence, 70% chance of cure. Any thoughts or opinions for me. Thanks.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

I think it will come down to a matter of personal preference for your dad.

Try the pre-treatment nomogram by Memorial Sloan Kettering at http://nomograms.org . You'll see that it doesn't matter 4+5 or 5+4. With Gleason 9 and PSA 5.5, stage T1C, the odds are slightly (63%) in favor of organ confined disease. He also has pretty good odds of being progression 10 years after a prostatectomy.

Of course, as you note, there are no guarantees. Staging now is an educated guess, and Gleason scores are often found to be different upon removal of the prostate.

Outcomes of radiation vs. prostatectomy are pretty similar as far as cancer control goes, maybe a slight edge to prostatectomy in the long run. Radiation is much easier to tolerate, especially external beam. Prostatectomy has the advantage of providing the entire gland to a pathologist for examination, as well as examination of lymph nodes and seminal vesicle.

I'd get Patrick Walsh's 2007 "Patrick Walsh's Guide to Surviving Prostate Cancer" to augment your research, but overall it sounds like your dad is doing well with consulting multiple docs and specialties. It might be a good idea to throw in a medical oncologist as well, especially considering that the urologist has already given him a dose of Lupron.

Just my non-qualified 2 cents.

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

johnw100 · Posted: Tue May 27, 2008 5:36 am Post subject: Re: New prostate diagnosis

Good advice from Replicant as always:

It often does come down to personal preference: There are often several treatment choices that can be equally effective, and a medical oncologist can help define and understand the potential side effects of each treatment.

Biopsy readings are subjective. To confirm where you stand, I would:

obtain a 2nd reading of the slides if that has not already been done,

consult Dr Klein or a medical onconogist,

question the suggestion of "non nerve sparing" surgery.

Best wishes.

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

I meant to say "He also has pretty good odds of being progression-FREE 10 years after a prostatectomy."

Lately, I have a bad habit of omitting words as I write. I think 'em, but I don't always write 'em!
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

brainman · Posted: Thu May 29, 2008 4:32 am Post subject: Re: New prostate diagnosis

john2723, Replicant and johnw100 are much more knowledgeable about prostate cancer than I am. I just want to voice my agreement with them. You and your father are in my thoughts and prayers.

Replicant, you too?? Laughing

_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

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