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Newly Diagnosed G9 - still working through options.
jupaul posted:
I'm 49 and other than this, in great health.
My PSA has slowly been rising from 1.8 in 2008 to now 3.5 in 2012.
I've also been taking propecia for about 12 years, so my PSA is artificially low.
Free PSA 2% (very very low)
1st Biopsy in May 2011 - all negative.
DRE normal - in fact the Doc said "amazingly normal"
2nd Biopsy in March 2012 after MRI to pinpoint areas that looked suspicious - 1 core positive out of 13. 15% involved, 3+5=8.
2nd opinion on biopsy pathology at John's Hopkins - 4+5=9, 40% involved in one core - dang, wrong direction!
Bone and CT Scans negative - but I realize with an 8 or a 9, these are not very accurate tests.

I'm seeing a very top Urologist/Surgeon in Chicago and may go for a 2nd opinion at MD Anderson in Houston.

Even with a likely G9 - I'm still leaning towards surgery - and not so much from the 'get it out' feeling, but just to be able to get a complete pathology report, know exactly what I'm dealing with, and remove that variable from the table. At only 49 - I'm not looking for a 10 year survival rate - I want 20 to 30 at a minimum!

I haven't been offered any sort of HT yet - I understand that's sometimes an option even before surgery for a G9, not sure if I should pursue that or not?

I guess my other question is - is surgery really worth it for a G9? I keep clinging to the fact that even if you double my PSA due to propecia, it's still low, under 10 - it's got a very slow velocity - my DRE is totally normal, so the hope is it's small and had to be found with an MRI - so I may get lucky with surgery. On the other hand if I've only got a 5% or 10% shot with surgery and will need radiation, maybe I should consider other things???

Thanks for any input!
billh99 responded:
Here are some prediction tools from Sloan Kettering.

If I got your data right surgery look real good.

Now my situation was much different then you (66 and 3 3), but one of reason that I like the surgery was just what you said. You get a complete pathology report including if there was any capsule penetration.
Fairwind responded:
You do the surgery, that MIGHT get it all, but if it doesn't, it will get 99% of it, that way, the radiation and HT only have to deal with the 1 or 2% that remain...Much better chance of success that way..With G-9, you don't mess around..You hit it with everything available to you..JMHO...
Basir U Tareen, MD responded:
For a 49 year old with locally advanced disease most experts would consider radical prostatectomy with a good lymph node dissection the "gold standard." Using various predictoin models you would be suprised to find that the cure rates with surgery alone are greater than 50% in some studies. We are always cautious in using the word "cure", but you will find most studies are discussing 5 and 10 year cancer free rates. (usually followed by looking at PSA). Obviously if one is free of disease at 10 years there is a very high likelihood of long term disease control.

I think you are taking the right steps by getting all the information. I often send my patients to see a radiation oncologist just for completeness since that is the other standard treatment option other than surgery.

In a 49 year old one downside to radiation is that with G9 disease you will undergo hormonal therapy along with the radiation. If the radiation fails, surgery is not a very feasible option in most cases.

If you undergo surgery, however, its possible that you may be able to avoid hormonal therapy altogether and in the event that there is persistent disease, positive margins, or recurrence, radiation is still an option down the road.

Best of luck and I'm sure once you have finishes your due diligence you and your doctors will make a decision that you are comfortable with.

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