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    I have just been diagnosed with Prostate Cancer
    rjorgeron posted:
    Over the last year, my PSA levels have increased from just over 4 to 6.1. After this latest jump from 5.4 to 6.1, my urologist decided to do a biopsy. I had the biopsy done on this past Monday, 2/21/2011. The doctor called me today to tell me that the pathology results do show prostate cancer. He gave me a Gleason score of 6. I do not know the primary and secondary numbers. He told me that he did feel that I should go home and worry about this because he felt that I was in good shape. He recommends removal of the prostate and even mentioned robotic surgery. I don't have a follow-up visit with him until 3/7 so he wants me to do as much research as possible on all of the possible treatments available so that we can have an intelligent conversation of what is out there and why he recommends removal of the prostate. The interesting thing is that I had absolutely no symptoms other than the increased PSA level. He said that the DRE and Ultrasound showed a normal size prostate. In fact, he said that it was small. Another thing to note is that my baby brother is currently undergoing treatment at MD Anderson for a very agressive form of prostate cancer. My PC is very mild compared to his. The good thing about his is that it just involves the prostate at the moment. Anyway, my wife would like me to get a 2nd opinion. I think that is a good idea, but it it is cancer, I feel like I should have them get rid of it as soon as possible. If that means removal of the prostate, then so be it. I would rather be incontinent and/or impotent than dead. Also, I have type 2 diabetes, controlled by diet and medication. Can you give me some advice on what I should do? I am 52 years old and I feel fine.
    billh99 responded:
    "He told me that he did feel that I should go home and (NOT) worry about this because he felt that I was in good shape."

    I hope that you left out the NOT is typing. I way too often make that mistake. Thinking faster than I type and sometimes a word or phrase gets lost. Although some of my "friends" will disagree and say that it is a sign of my "thinking" <G>

    Most likely your 6 is a 3 3. I think that a 2 4 would be a very, very unusual situation.

    You might be a candidate for Active Surveillance Treatment. That is continuous monitory including periodic biopsies to see if and how fast the PC is progressing. In general many PC cancer is slow growing and does not need treatment. But you are young, which means lots of time for it to grow. And you have a YOUNGER brother with an aggressive form.

    And based on your statement I have the feeling that you would not be comfortable waiting.

    Another problem that I had with waiting was at my age, 67, in 5 to 10 years when treatment was needed was that I might not be as healthy to have surgery.

    There are a few genetic test that do look for factors that indicate fast growing PC. But I don't think that any are yet recognized as being really definite.

    "Anyway, my wife would like me to get a 2nd opinion."

    To what end?

    It is very, very unlikely that the pathology reported PC where there is none. But it is human judgement as to what the grade of the cells are.

    The basic treatments are removal or radiation. And of the radiation treatments there are a number of different favors. And there are a couple of others Proton (which is a type of radiation), cryogenic, and focused ultrasound. Those are still experimental and/or available at limited locations.

    If the biospy or other test indicated the possibility of more extensive and/aggressive PC then hormone therapy is sometimes used at the same time as the radiation (and maybe surgery).

    As I see it the only reason to get a 2nd opinion is to help decide if you need more extensive treatment.

    John Hopkins will go a 2nd opinion by "mail" from the pathology slides and written reports.

    And of course the doctors at MD Anderson that are treating your brother would be a great resource.

    And if you do contact MD Anderson ask them about taking finesteride or duristride in the meantime. New research shows that duristride slow the growth of PC cancer. And MD Anderson is currently running a trail in the use of finesteride between the time of detection and time of surgery.

    Now this is not an emergency. You have some time to do the research and make up your mind.

    Here is another thread that is very similar to yours.
    Fairwind replied to billh99's response:
    Since the Gleason grade will in large part determine your treatment, making SURE a Gleason 6 is really a Gleason 6 is a smart investment. Gleason 2 cells are not considered to be cancerous. Gleason 3 cells are..A fine line. Get the second opinion..

    Two good books to get you up to speed..Walsh's "Guide to surviving prostate cancer' and "Winning the battle against prostate cancer" by Gerald Chodak will give you the knowledge you need to talk intelligently with your doctors..

    Best of luck to you..
    frogs1936 responded:
    If you are located anywhere close to MD Anderson or visiting your brother there, take advantage of the expertise there and consult with them. They can review your biopsy slides and confirm the original evaluation. Since you appear to have early stage PC, you may be able to take advantage of the proton radiation available there. That may give you the fewest side effects and best quality of life. However, you will need good insurance as it is an expensive treatment.and a couple of months of time.
    rjorgeron replied to Fairwind's response:
    I have actually gotten a 2nd and 3rd opinion. I spoke with a radiation oncologist about various forms of radiation treatment for my cancer. I liked what he told me about the Cyber Knife treatment and if I was to undergo radiation, that is the procedure I would undergo. I also spoke with a doctor at the Malizia Clinic in Atlanta. This is a not-for-profit clinic that was started by Bernie Marcus, CEO of Home Depot, when he had prostate cancer a few years ago. The doctor there actually upgraded my cancer to a Gleason 7 because of the 1 Gleason 7 (3 4) sample on my biopsy. He was very straightforward with me and my wife and we both liked him and the staff at the clinic immensely. We were treated like human beings, unlike the treatment at my urologist's office. That office is a very large practice with a lot of patients which limits the time spent with your doctor. At the Malizia clinic, we spent over 2 hours speaking with the doctor and his staff. Dr. Wong is an expert in the DaVinci surgery, having performed thousands in his career. He also is one of the only doctors in the country that does a procedure called Nano Knife for prostate cancer.

    The Nano Knife procedure consists of putting several needle electrodes into various precise spots in the prostate and then sending micro bursts of hi voltage electricity into the prostate. This procedure targets only the prostate cells and essentially puts holes in the cell walls. Since a cell cannot live without a whole cell wall, the cell dies. Some good cells do get zapped, but the doctor tries his best to target only the cancer cells. Dr. Wong was the first urologist in the US to perform this procedure back in 2009. Of the 50 done in the US, he has done 35 of them. The thing I like about this particular procedure is that if the cancer does return, I have every treatment option open to me, including the Nano Knife. I like that very much since I am determined to have a plan B in case Plan A does not work. With all forms of radiation therapy, surgery is not a very viable option should the cancer return.

    I am planning on undergoing the Nano Knife procedure in June. I want to lose some weight before having this procedure. If anyone reading this has had that procedure done, I would love to hear your story.
    billh99 replied to rjorgeron's response:
    I had never heard the Nano Knife before and I googled it.

    And I found this at Healing Well

    And it includes the report of one person who had it, but no long term follow up.

    But I have the same concern as one of the posters in that thread.

    PC can be very diverse and I wonder how well that they can be sure that get it all.

    It is not unknow for people to have rising PSA and undergo biospies for several years before they get the firs positive hit. Meaning that they keep missing it.

    You might search Healing Well to see if there are other reports.

    I also found this.

    "Another thing to note is that my baby brother is currently undergoing treatment at MD Anderson for a very agressive form of prostate cancer."

    With that I would personally want to get a review from a pathologtist that specializes in PC and look at the cells and get more indication of the agressiveness. Also maybe some genetic tests.

    One of the things that it is hard to tell in PC is if your cancer is less agressive than your brothers or has just not developed as far.
    An_216511 replied to rjorgeron's response:
    Good luck with your treatment. Like you, my biopsy showed a Gleason 7 (3,4) and a small prostate. Only after surgery was it clear that I had an aggressive form of PC (Gleason 9, seminal vesicle involvement and extracapsular extension). Just something to consider. You can't know for sure if the cancer is confined to the prostate and whether it is aggressive or not from biopsy. By the way, I had surgery 2 years ago and I am not incontinent (or dead).
    rjorgeron responded:
    This is a followup. Yesterday, 6/8/2011, I had my 3-month post Nano Knife procedure. I had the procedure done in June. I am extremely happy to say that my PSA came back as undetectable. My doctor was extremely pleased with the results. He also did a urinary flow analysis and I blew his expectations out of the water. I was not having any issues with urinary flow before the procedure, but he said that the tests on yesterday showed that my flow had improved from before the procedure. If anyone with PCa is able to make it to Atlanta, GA, please do yourself a favor and visit the Jenkins Clinic and speak with Dr. Wong about the Nano Knife (Irreversible Electroporation of the Prostate). You will very happy that you did. Dr. Wong is also an excellent surgeon and has performed hundreds of DaVinci procedures. He is also number 1 in the world currently with the Nano Knife procedure on the prostate.
    itsmebusyguy replied to rjorgeron's response:
    I considered these procedures, I have a Gleason 7 (4 3). Today was my 8th of 40 Radiation Treatments; At this point in time, I am very happy that I opted for this vs. surgery (DiVinci), or CyberKnife or NanoKnife. I'm confident any of these will "cure" my cancer, but I don't have to miss work; don't have the incontinence issue to deal with; and hopefully, the erectile function will remain for many years. GOOD LUCK to you in whatever decision you make; At this point, I can't imagine doing any other procedure. 30 minutes a day at 3:40PM.
    Goals are the KEY to Successful Living
    JDWILSON6969 replied to itsmebusyguy's response:


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