Prostate Cancer Community

A surgeon will nearly always recommend surgery, because that it his business. You should investigate all of the options before committing to any treatment. I opted for proton therapy because it has zero to minimal side effects, and I'm very happy with the results. I have had no side effects. Surgery can have temporary or permanent impotence and/or incontinence, depending on the individual and the surgery. My gleason was 3 4 and PSA was 8 before treatment. Talk to one of the proton treatment centers, which you can find on the internet.

To get yourself up to speed, pick up a copy of Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer", available at any library or bookstore. That way you will have a far greater understanding as to what your doctors have to say next week..Gleason 6 is good, PSA 2,7 to 4.2 in six months is not good...

Yes, surgery is one option and urologists are biased towards it, especially if they are also surgeons...But radiation has made big advances and can now compete with surgery on a more or less equal footing..So it kind of boils down to what side-effects you want to deal with both now and in the future..Both the surgeons and the radiologists tend to minimize the side-effects and the risk of complications when they make their sales pitches..

So read Walsh's book (he is a surgeon but he tries to be unbiased) and prepare to become pro-active in deciding your treatment....Best of luck to you!

I AM SORRY TO HEAR THAT YOUR HUSBAND WAS RECENTLY DIAGNOSED WITH PROSTATE CANCER. THIS IS USUALLY AN EMOTIONAL TIME FOR MOST COUPLES FACING THIS NEW LIFE EXPERIENCE. FORTUNATELY, FOR MOST MEN, THE OUTCOME IS FAVORABLE AND "LIFE WILL GO ON".
WHILE I CANNOT PROVIDE SPECIFIC MEDICAL ADVICE FOR HIS CASE, I CAN TELL YOU THAT THIS IS VERY TYPICAL FOR MANY CONTEMPORARY YOUNG MEN WHO ARE DIAGNOSED WITH EARLY CURABLE CANCER. LISTED BELOW ARE 20 QUESTIONS THAT YOUR HUSBAND, AND EVERY MAN FACED WITH THE DIAGNOSIS OF LOCALIZED PROSTATE CANCER, SHOULD ASK HIS DOCTOR:
1. WHAT IS MY CLINICAL STAGE, MY GLEASON GRADE AND MY PSA LEVEL?
2. WHAT RISK GROUP (LOW, INTERMEDIATE OR HIGH RISK) DO I FALL INTO?
3. WHAT ARE THE PROS AND CONS OF THE VARIOUS TREATMENTS INCLUDING RADICAL PROSTATECTOMY, EXTERNAL BEAM RADIOTHERAPY, BRACHYTHERAPY, ACTIVE SURVEILLANCE AND OTHER LESS COMMON TREATMENTS, SUCH AS CRYOTHERAPY?
4. IF I CHOOSE RADICAL PROSTATECTOMY, PLEASE EXPLAIN THE PROS AND CONS OF SMALL-INCISION OPEN RETROPUBIC PROSTATECTOMY AND ROBOTIC-ASSISTED LAPAROSCOPIC PROSTATECTOMY?
5. IF I CHOOSE YOU (THE DOCTOR YOU ARE SEEING) AS MY SURGEON OR RADIATION ONCOLOGIST ETC., WHAT ARE YOUR SPECIFIC OUTCOMES AND HOW MANY OPERATIONS/PROCEDURES HAVE YOU PERFORMED AS AN ATTENDING PHYSICIAN, NOT COUNTING RESIDENCY OR FELLOWSHIP?
6. CAN I HAVE A NERVE-SPARING SURGERY TO ALLOW RECOVERY OF MY PENILE ERECTIONS?
7. WHAT ARE YOUR (THE SURGEON'S) RESULTS WITH NERVE SPARING SURGERY?
8. WHAT ARE YOUR (THE SURGEON'S) RESULTS WITH URINARY CONTROL RECOVERY AFTER THE SURGERY?
9. IF I CHOOSE RADIATION THERAPY, WHAT ARE YOUR (RADIATION ONCOLOGIST'S) SPECIFIC RESULTS REGARDING CANCER CONTROL AND SIDE EFFECTS?
10. WILL MY ERECTIONS RETURN AFTER RADIATION?
11. WILL MY BOWELS BE AFFECTED BY RADIATION?
12. WILL MY BLADDER BE AFFECTED BY RADIATION?
13. WILL I HAVE AN INCREASED RISK OF OTHER CANCER DEVELOPING AS A RESULT OF THIS RADIATION IF I LIVE LONG ENOUGH?
14. IF I CHOOSE ACTIVE SURVEILLANCE OR WATCHFUL WAITING, HOW OFTEN WILL YOU (THE DOCTOR) FOLLOW ME AND WHAT TESTS WILL BE NEEDED PERIODICALLY?
15. WHAT OTHER TREATMENTS, SUCH AS CRYOTHERAPY , DO YOU (THE DOCTOR OR THE PRACTICE) PERFORM?
16. SHOULD I HAVE A SECOND OPINION?
17. SHOULD I HAVE A SECOND OPINION BY ANOTHER PATHOLOGIST TO REVIEW MY BIOPSY SLIDES?
18. WHEN SHOULD I HAVE THE TREATMENT OR IS IT OK TO WAIT FOR A WHILE?
19. WHAT WOULD YOU DO IF THIS WERE YOUR CHOICE? (GENERALLY SURGEONS WILL RECOMMEND SURGERY AND RADIATION ONCOLOGISTS WILL RECOMMEND RADIATION, BUT THIS IS STILL A USEFUL QUESTION IN MY OPINION.)
20. WHO ARE THE NATIONAL-INTERNATIONAL EXPERTS IN MY AREA IF I CHOOSE TO GET A SECOND OR THIRD OPINION?

Thank you for response and information. His appt is scheduled for the 16th near Tulsa. We also checked out what our insurance will cover and who are the best surgeons in Tulsa and types of surgery, etc. I am taking your list of questions for discussion. I will let you know after the 16th of Nov. Appreciate the help. Linda

There is a proton therapy center in Oklahoma City which may be near you. I suggest that you call them to discuss the problem. It doesn't cost anything, and you may learn something valuable. I'm very glad that I decided to do that.

I followed up on your suggestion and showed all to my husband when he got home from his job. He is very interested in Proton Therapy. Thank you and we will take info to appt with doctor. Sure sounds better than surgery and other options. I still want him to have CT scan first so we can see and know more about the tumor etc..

Do check into all your options but be aware that not everyone will agree on the "right" treatment and each of our individual experiences may not work out the same for you. Get more than one expert opinion

http://prostatecancerinfolink.net/2010/11/08/an-interestingly-high-level-of-gu-complications-after-pbrt/

I'm glad to hear that you're keeping your options open. Please keep us informed about your progress. If you want any more info, just ask.

Well, my husband decided to have the Da Vinca Robotic surgery as the Proton trmt would be 9 wks, x5days per wk. Also over 300 miles per day. We decided we could not afford the gas let alone the medical costs. He sees the Surgeon in Tulsa 12/14/10.
Regarding biopsy it was positive in 9/12 samples. Stage 2 and slow not aggressive. Was told cath. would be in bladder for 10 days post op. The Surgeon has 5 yrs experience with robotic assist. He has appt tomorrow about cough and lowback/hip pain. I will keep you posted on updates. Thanks for advice.

I'm sorry that cost had to be the main factor in your decision, but I wish you and your husband the best of good fortune.

Dr. Moul, I like your list you have provided. Id like to ask you a question regarding the Prostrate. Currently I am taking Avodart. I have BPH. My PSA tests always come back ok but I still experience the symptoms that I thought the drug would help me with ie' weak flow, stop and starting,and then there are some nights, I have to get up and urinate every hour, this happens on occasion, not daily though. Could it be more of a bladder condition, kidney problem? What kind of tests are available to clear me? Thankyou

I would recommend using Protocel for cancer treatment of the prostate. It is a slow growing cancer and that gives us time to make the best decisions. I have been on Protocel for 9 months and my PSA went from 16.4 to 10.9. It was 21.0 at it's highest. Ron Adams Albuquerque, New Mexico.

Actually his Gleason Score is not that bad. Mine was 7. I just had the robotic surgery and was up and moving aroung the next day. Yes, I was sore but not as bad as I thought. I only took pain medication twice a day, I could have taken it up to for times a day.My PSA was 19 but it was only in the prostate. I have talked to my doctor about the impotent and it is due to nerves that has been cut. I am 52 and wasn't so worried about that but my wife and I are dealing with it one day at a time. I just went last week for my monthly checkup and they gaome me a pump and it works great. I do take a pill every night but that is not my main concern. Bladder control is going to be the hardest part for me. I cough a lot and this causes me to leak. I also have to get up and down alot at work and that causes it as well. I was back at work one week after surgery but I do have a desk job. However, I am back to walking about 25 minutes on the treadmill at night and doing situps with the ab rocker, about 50 per day. I hope that this has helped. Check this out...3 days after prostate surgery this was great to watch

My husband is 5 weeks post robotic surgery. His biopsy was 14 of 14 samples with a Gleason score of 7. Cancer had spread outside prostate and we are meeting a radiation specialist Friday to plan the next stage. The surgery and recovery has been remarkable. He had the cath. for 6 days, experiencing some leg pain, but walking helps with both the leg cramps and the bladder control issues. He was back to work in 10 days. One web site I have found has been helpful in understanding what we are facing...Project Zero....Look it up. I will say a prayer for you and your husband.