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I can only say what I would do if I were you, John A. (But please remember I am not a doctor - just a man who had a similar diagnosis). With such a small amount found and with such VERY low PSA, I would W/W.
At your age I waited for about 6 months and then had a partially unsuccesful Robotic (didn't get whole prostate out). Looking at my post op pathology plus follow up sequential MRI scans, my new uro says he thinks I need not have had the op. Woops! I am still watching and waiting but could have been doing it without the life changing side effects I now have.
Please read Terry's story very carefully and do not rush into anything.
Ted mentioned your low PSA score so I thought I'd add something I forgot in my first reply. Your case is one of those that proves PSA is NOT a true indicator of Prostate Cancer. In the beginning they said 4.0 was normal, now they're pushing it down to 2.5, but yours is only 0.7. If you're interested in Watchful Waiting you might want to search the internet for articles by Dr. Thomas Stamey, he's one of the pioneers of the PSA test but has changed his views after researching it for years. I'll put a couple of quotes and links to some of his articles.
Quote
Stamey cited a 1996 study in which researchers examined the prostates of healthy men who died from trauma, finding that 8 percent of those in their 20s already had prostate cancer.
Stamey said prostate cancer is a disease "all men get if we live long enough. All you need is an excuse to biopsy the prostate and you are going to find cancer."
Stamey has come to believe that elevated PSA levels (between 2 and 10 ng/ml) actually reflect a condition called benign prostatic hyperplasia, a harmless increase in prostate size. He published his conclusions in the Journal of Urology in 2002 and 2004.
In his talk, Stamey explained that the basic dilemma is that men who have elevated PSA levels frequently undergo biopsy, which will almost always find cancer.
"If we all have it, all you need is an excuse to biopsy the prostate and you're going to find it," he said. "You want to be careful about being biopsied because the odds are against you" being found free of cancer.
Finding cancer does not necessarily indicate that prostate removal or radiation treatment is required, Stamey emphasized.
Choosing Watchful Waiting is hard since you have to live with the uncertainty of your prostate cancer diagnosis. My advice is to do A LOT of research and discuss it with your Doctor.
There is NO DOUBT that prostate cancer CAN BE A KILLER but often it's slow growing and treatment might not be the best thing. But waiting is something YOU need to decide on, don't let ANYONE decide your treatment choice.
As an update I spoke with my cardiologist yesterday (2/24/09) who told me surgery would be okay based on my heart health. (I must have really bungled my explanation of my heart condition when I explained it to the urologist.) Anyway, he looked over my biopsy report and suggested not waiting and utilize external beam radiation treatment.
I made another appointment with the urologist for the middle of March to discuss these options again. This time I hope to be armed with information from reading, forums and other doctors when I discuss these proceedures. I was just too taken aback when given the diagnosis and the need for a decision for treatment at the same time. I might keep it the same but I need to talk more about the options. Does anyone have experience with the external beam radiation, seeds and surgery?
I suggested going through the Website. If you take the time to do that you will find literally hundreds (almost 600) stories from men who have been down the track before you, have chosen their treatment options and who are happy to share the outcome with men like you. It takes a bit of effort on your part, but is worthwhile.
John A - the other thing I meant to say was that I would also get second opinions. You should get a second opinion - or even third - on your biopsy. You had only one needle in 14 affected. You say now that your uro is urging radiation without delay. You need to see another uro for a second opinion on that. You have plenty of time for these other opinions IMHO.
Maybe try to find a uro who is open to W/W as well as the more usual ones who urge their brand of immediate treatment.
As for your questions about treatment, just look carefully at all the mentor experiences here on this web site. They are catalogued by treatment preference or age or PSA.
John,
UCLA is currently working on a new imaging protocol for staging PC and could be very useful for those on watchful waiting. They are fusing MRIS, DCE and diffusion MRI with ultrasound to get a very accurate picture of the prostate. I would look into it as accurate staging is the most important thing you can do in determining a treatment option.
JohnT
