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    help needed 4 type of treatment
    kensoldlady posted:
    my husband (60) biopsy lab report says 3+4=7 Gleason, Stage is T1c, Partin table says 63% oc. His PSA went from 2.0 to 4.7 in a year so had biopsy done April 6, 2011. Second Dr. reported that he was a T2. 5 out of 10 samples were malignant with 1 being 80% and another in the 70s. All malignant are on one side. Our difficulty is deciding whether surgery or radiation is the best, being we are not convinced the cancer is organ confined as the percentages don't seem in our favor. We read that you can't have surgery after radiation. We/he was thinking of radiation but we are nervous about finding a good doctor. We live in the NW corner of MN. and would travel to Minneapolis if you can recommend someone. Any advice is appreciated. OC or not? Surgery or radiation?
    23jld responded:
    I don:t know about mn. but I had the surgry 7 years ago (yeaaaa) i went from 2.o to 4.7 in 6 months had test done I chose the devinci surgry out come was great they did NOT cut the nerve so every thing still works great I was 44 at the time. I went to urology of ind. in indy Dr. John scott is a great man
    Gottano responded:
    Don't know how difficult it is travelling from NW corner of MN to Minneapolis, but I'm sure Ken's doctor told you that radiation may require him to go for treatment 5 days a week for as long as 7 or 8 weeks. Just one thing to consider. As for organ-confined cancer (mine was not), that doesn't mean a surgeon can't get all of it. If, however, you mean that there may be cancer cells at distant sites, no one can say for sure that's not the case, but neither surgery nor radiation (both local treatments) can take care of systemic disease. By the way, I think it's also not unusual for Gleason scores to go up from the biopsy to the path report following surgery (mine went from 7 (3 4) like your husband's to a 9. That's something you won't find out after radiation therapy. Good luck. It's a personal decision (actual it's a family one) but don't rush into the first recommended treatment. Don't know what's available where you are, but if the extent of the cancer is in question, there are tests (transrectal mri, e.g.) that you could ask about before treatment.
    kensoldlady replied to Gottano's response:
    Thank you so much for the responses. He likes to go a couple days just not talking/thinking about it. He reads many of these forums and the experiences are so real and eye opening... really grateful for the opportunity to connect with you. He is leaning towards radiation. His main concern is what his next best option would be if the cancer returns after radiation? Also please give more info about tests to help show the extent of the cancer. We focus on the lab report and docs tell us it is "assumed" (His brother had the surgery and doesn't recommend it, and the "assumption" of 'organ confined' also puts a stress on the surgery option)
    Gottano replied to kensoldlady's response:
    I'd like to go more than a couple of days not thinking about it. It's not possible but I found that I could go without talking about it - it wasn't fair to my wife, as it's not fair to you now but I hope you understand and I hope he'll find it in him to discuss this with you. You sound very sympathetic and supportive. I'm no expert, but I think you can be certain that your husband's experience will not be exactly like any other individual's treatment/results. For every testimonial I read about a great experience with no side effects, I read or hear more from the other extreme - there's no perfect, magic cure. Still, it's good to get as much information as you can. I wish I had taken longer in deciding on a course of action but I'm okay with my decision now. I am also 60 and about 2 years ago my urologist steered me towards surgery (although he no longer performed them).after a positive biopsy and questionable DRE. He said there would be side effects with either surgery or radiation and they were roughly the same effects (although problems from radiation might not show up until later.) Because of other medical problems, I wasn't interested in radiation and I opted for Robotic Assisted (Da Vinci) surgery. Surgeon was good - he had already done over 500 procedures. Only later did I learn that there are some treatment centers that routinely have endorectal mri done before surgery so they have an idea of the extent of the tumor. (It's an expensive and somewhat uncomfortable procedure, especially if you are claustrophobic.) I was told that we could have known in advance that my tumor had grown outside the prostate and the cancer involved the seminal vesicles. Don't know if that would have made any difference in my decision but one oncologist at Dana Farber suggested in a follow-up opinion that surgery may not have been not the best choice in this case). However, so far I'm happy with the results and almost completely recovered. I've read about some surgeons who will do radical prostatectomy after radiation but probably the next step if/when radiation fails is androgen blockade (hormone therapy). There's a ton of information out there and it's easy to get overwhelmed. I found some comfort in a book by David Servan-Schreiber called Anticancer: A New Way of Life. Additionally, the web site has good basic information for the newly diagnosed and is continually updated with the latest PC information. Some of the regular contributors here have been through radiation and can give you and your husband some great advice, if that is the way you (Ken and you) decide to go. Best of luck to you both.
    bogie11 responded:
    You should investigate proton radiation. It has minimal to zero side effects. It is available in several places in the country. I had it two years ago, and I'm doing as well as before. The experience was great, there was no pain during treatment, and I cotinued my normal daily routine except for about half an hour a day. An additional plus was that my wife and I made several new friends who were doing the same thing.
    Fairwind responded:
    Radiation has made great advances over the last 10 years, Surgery has made some minor improvements over that time period..Today, in my opinion, the combined therapy of seed implants and beam radiation seems to provide the best possible outcomes while minimizing side effects..

    You will probably have to travel to have the brachytherapy part, but maybe the beam (IGRT) radiation could be performed locally. Talk to a Radiation Oncologist about this...

    You might wish to read Gerald Chodaks book, "Winning the Battle Against Prostate Cancer" to get an unbiased viewpoint...
    WWfromCA responded:
    I am 65 and had 3 4 gleason when I was 59. made appointment to have surgery and while waiting for surgery date did a lot of reading. Cancelled the appointment and went on about living my life. There are too many studies that show the result of doing nothing is very similar to doing surgery or radiation. Everyone who does something has to deal with the side effects of the choice rhey make, doing nothing, you get to live a normal life with some additional worries. There is a recent study from somewhere in Europe suggesting that with thousands of men in the study the number of men who die from prostate cancer is about the same in the two groups. those that waited and those that had immediate procedure.

    God luck with your decision. From Mn. living in CA.
    Fairwind replied to WWfromCA's response:
    What was your PSA in 2005 and what is it now WWfromCA??
    billh99 replied to WWfromCA's response:
    If you read the details of that study you will find that patients where much different then in the US.

    PSA screening where not done.

    So the cancer was detected by either digital exam or when the PC started giving symptoms.

    So, on the average, it would be more advanced then the average US patient.
    rockmaned responded:
    Hope things are going along for you. I'am in so. mn. I'am 55 with a Gleason of 7 also. Going for Da Vinci surgery 9-1 at Mayo. If you're in good shape, they say go for surgery with radiation if the cancer comes back. I see your blog is 3 months old. Let me know.
    kensoldlady replied to rockmaned's response:
    Hello. DaVinci was done last week on Thursday, by Dr. Frank. (hope it's alright to name him). Read a ton of material on the Internet (including all the help from this site and others like it, men with experience talking) to help decide what to do and also to find the place/doctor to do it. In preparation drank lots of pomegranate, did kegel exercise, and walked. Wednesday was spent in classes put on by Mayo. Thursday reported at 8:15, was wheeled away at 10:58, moved to surgery room for prep at 12:47, surgery started at 1:36, closing up at 3:30, wheeled into care unit room at 6:45. It's a long day! Started walking that evening. The next morning doctor visit and was discharged that afternoon. Catheter for one week. Follow up in 3 months. Moving slow but taking very little pain medication. Have 5 or 6 little incisions on gut. Took a lymph node at beginning of surgery, sent it for analysis right away, came back negative, and after surgery sent the whole thing to find out if any cancer spread outside the prostate wall. (they don't think so, but want to be sure). Feel blessed. Good Luck.
    Gottano replied to kensoldlady's response:
    Happy for you that the operation went well and I wish Ken a speedy recovery with minimal side effects. Be sure to get a copy of the pathology report for future reference and follow-up treatment opinions, if necessary. PSA at about 6 weeks after surgery (ultrasensitive test, not the original screening PSA) and the specifics from the path report will give you a good idea what to expect for the future. Best of luck to you both.

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