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I have to second(and third)the advice Do Not Panic. Your father and family should take all the time needed to study all options. With a Gleason of 6 you do not have to rush. I know its hard hearing the "C" word. Fisrt impulse is AHHH get rid of it now. Do not give in to first impulses. I have only been diagnosed for three months so I am still searching and learning. The first thing I have learned is that for most men there is time to carefully consider options, research the docs giving the treatment, and then choose what feels right. It seems there is no definitive "right treatment option" out there. Every one has its own benefits and risks and when you boil it all down, all have seem to have similar results.
Thank you so much to everyone who has responded (and emailed). We go to meet with the radiologist tomorrow morning re: seed and IMRT.
Is there any place I can find the scientific studies of the recurrance rate over 5,10, or 15 years for someone similar to my dad (aka, 71, 4 of 6 biopsys, 3+3 Gleason) based on each treatment option?
I think he's leaning towards surgery with the belief that it will give him the best chance at a cure and save the radiation treatment options for later (since I hear you can only get radiation one time).
Also, would you recommend having his biopsy slides sent to like John Hopkins for a second opinion?
The "amount" of tumor is what concerns me a little (4 of 6 positive and tumor on left and right - T2c). Our urologist said there was an almost 0% chance that it had metastisized and he wouldn't recommend him having any additional tests at this time to see if it's spread (aka, the bone scan or die tests). Does that seem normal? Are the tests extremely accurate? Knowing for sure might help our decision.
Beth:
I agree with those who have posted that time is, indeed on the side of your father. I think that many urologists who see a man with clinical factors such as your father would not refer to CT scan or Bone scan because the chance of gross metastasis is so small. To address your question directly, for those men who are curable, radiation OR surgery, performed by the very best practitioner (KEY ITEM) can be equally successful. If there were a clear and obvious advantage to one, then that is what everyone would choose. Surgery has risks that radiation does not have, and these risks accumulate with age at treatment. Continence and potency are both affected by each treatment. With the G score and doctor opinions you mention then it is certainly likely that your father will not die of prostate cancer. Repeat: statistics show that men in the position of your father are most likely to die of other causes.
My situation was fairly different from your fathers on several counts - my age (40) being the biggest variable - so I can't point to any specific advice on best treatment plan but I have a couple of thoughts based on my own experiences.
First, yes, get the sample reviewed by another pathologist - Dr Epstein at Hopkins is probably the name most often mentioned - I sent my sample to him but it was also reviewed by the two top surgeons (or their own pathologists) who I met with.
Second, like everyone says, don't panic. I took my time (4 months) making a decision (having a Gleason 3+3 and 6% positive in one core I felt comfortable with that). It's important to remember that every specialist has his own preference - surgeons will want to perform surgery, radiation oncologists will want to perform radiation, etc. To compound it further, open RP surgeons will play down robotic data and robotic surgeons will advance their own claims of recovery rate and side effects. Probably the most important thing is to find the best team of doctors for treatment and feel confident in their ability to effect a cure.
