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I think you start with a urologist - with the knowledge that they lean toward surgery. But he/she would be the one to do a biopsy. Maybe do a free psa test first - though that may not matter much.
If you talk to a radiologist - they like radiology, and I suppose there are a few more treatments that the provider of those treatments would be really positive about.
Read a lot for yourself and read this site over and over. Keep asking questions - there are a wide variety of views here - mostly knowledgeable and sympathetic I think.
If the biopsy finds cancer - consult with three or so doctors.
Rchard:
In general the more research you undertake the better questions you will ask of the various practitioners you encounter as you proceed and the better decision you will make regarding your treatment.
You may find the following book by Bob Marckini helpful: "You Can Beat Prostate Cancer..." His chapter on the advantages and disadvantages of the most common forms of treating prostate cancer is especially informative. This book is readily accessible, an easy read and well worth its modest price.
Best wishes Don O.i
I am very new to prostate problems, and am fairly confused and frightened, but am trying to learn about PC. I am 74, in reasonably good health, and have a PSA of 12.6. I will see a urologist in a few weeks to follow up.
Based on my reading on this site, I appreciate that the type of doctor I see will have treatment biases, such as an urologist favoring surgery. Given these biases, what is recommended as to obtaining a balanced medical opinion for prostate treatment? Is an oncologist any better? Is a general physician (my doctor) the best one to give unbiased advice?
Thanks in advance for any assistance.
Hi there,
Sorry to hear that you have some prostate issues. Did you get your PSA test through a general physical?
In any case, the next step, with a PSA in that range, would probably be to have a highly experienced urologist perform a biopsy.
If prostate cancer is detected, the next steps would be guided by the biopsy report. The report would note how many cores were taken, how many of them were positive, the Gleason scores of each positive core and the percentage of involvement in each positive core. It might also estimate the staging of the disease.
At this point, depending on the seriousness of the report, a second opinion could be sought from an independent lab.
If prostate cancer should be confirmed, you would want to talk with your urologist, who hopefully is very experienced and competent. See what the uro recommends. As others have noted, they are usually surgeons and often recommend treatment based on their own speciality.
At age 74 you are on the cusp of when surgery would be considered. However, my Dad underwent open prostate removal surgery at the age of 73 and did very well.
In any case, you would also want to visit a highly experienced radiation oncologist.
Then you will have amassed some information on the pros and cons of both surgery and radiation. At this point, you can make an informed treatment decision based on what makes you feel most comfortable and confident.
Hopefully, none of the above will be necessary. But with a higher PSA reading, there is a chance that prostate cancer could be detected.
I would also highly recommend that you read a gold standard book by Dr Pat Walsh called the "Guide to Surviving Prostate Cancer." You'll find answers to many of your questions in this book.
Hi Richard and welcome aboard. Earlier this year I completed an analysis of the member stories in the YANA database. After reading your posting I had a look at the analysis to find men in a comparable situation to yourself, bearing in mind of course, that these men were diagnosed with prostate cancer.
Ok so I found 10 men of a similar profile to yourself. They were all in their 70's, had PSA'a between 10 to 20, were staged at intermediate (8) to high risk (2). Four men had surgery, three had radiation, one had cryotherapy, one hormone therapy, and one chose active surveillance. But the good news is, they all basically did well, with only two having passed on. Bare in mind the analysis was since YANA started in the mid 90's to Dec last year.
Richard given your stage of life, time is certainly on your side. If you should be diagnosed with PCa, the chances are that you will die with it, rather than from it. Even with high risk disease, you can look forward to many quality years of life ahead.
Many thanks To everyone who replied and will reply.
I forgot to add that my prostate is enlarged, and voiding is frequent and minimal.
The main points from all replies seem to be: follow through with good doctors and physicians, do your own research, and keep asking questions.
Along these lines I will start a new post asking for references for centers/doctors in the northern Virginia area.
It is a lot easier to go through this with support than to try it alone, so again, thanks to everyone. This site is terrific!!
It is all a bit daunting Richard, I know having been there myself. One you know just what you are dealing with, the weight on your shoulders will be considerably less. Do let us know how you get on?
WCV
Many thanks To everyone who replied and will reply.
I forgot to add that my prostate is enlarged, and voiding is frequent and minimal.
The main points from all replies seem to be: follow through with good doctors and physicians, do your own research, and keep asking questions.
Along these lines I will start a new post asking for references for centers/doctors in the northern Virginia area.
It is a lot easier to go through this with support than to try it alone, so again, thanks to everyone. This site is terrific!!
Richard B
Hi Richard,
After reading your additional information, it kind of parallels the situation I was in. One difference is that I was 61 when diagnosed, so there is a significant age difference.
In any case, I had a horrible case of BPH (enlarged prostate) before being diagnosed sith PC in 2011. I might have opted for radiation, except for the BPH. I consulted with a radiation oncologist at Mayo Clinic and he recommended that I have surgery.
He noted that either radiation or surgery could cure the cancer -- but only surgery could also eliminate the terrible urination problems I was having from the BPH. The huge size of my prostate (4x normal size) made radioactive seeding (brachytherapy) unfeasible because the seeding needle would not be able to reach all the angles in such a large prostate. But external beam radiation would have worked fine, he said.
But the overlying thing was the urination problems. So I followed his advice and had da Vinci surgery at Mayo. I was almost 100% continent the moment the catheter was removed and can now go all night without hitting the bathroom -- and, when I do go, I can go like a firehose.
So, if you should happen to be DXd with prostate cancer that requires treatment, surgery could be an option -- if your age will permit it and if your urination symptoms warrant it.
Otherwise, radiation would probably work just fine if urination is not an issue (and is not expected to be in the future).
Chuck,
Your remarks on problems voiding are probably close to my situation, although I have not yet had a biopsy. I will keep the surgery option in mind after my initial consultation with an urologist on May 14.
I certainly would appreciate comments from anyone else on problems with solutions to voiding problems, since this is an immediate issue for me.
Thanks again for assistance through this Strange Place.
Yes, my urination problems were so severe that you could name a location in my area and I could list the finest bathrooms to visit.
It was taking me 10-15 minutes of spraying & dribbling to completly void.
When I explained this to the Mayo radiation oncologist, he confirmed my thought that surgery was best in my case since radiation could not take care of the BPH.
The day before my surgery at Mayo, my surgeon performed a cystocopy just to get an idea of what he would be dealing with and confirmed that "you have a whopper of a prostate."
He explained that prostates of my size (98.3 grams) often tend to twist and deform and also can encroach into the bladder neck. He then reassured that my only logical treatment option was the surgery.
Today, I marvel at how fast and strong my stream is and have pretty much forgotton the locations of all those fine bathrooms. LOL
In the years before I was diagnosed with prostate cancer, I used to muse that it would almost be a "blessing" if I ended up with PC, as long as it was a curable case -- because the surgery would "relieve" me of all those urination problems.
So, if your prostate size happens to be similar to what mine was, at least you have some advance ideas of what might be the best way to deal with it.
Richard I also had frequency and incomplete bladder emptying prior to being treated for PCa. Like you I had a very large prostate. The PCa was treated with Radiotherapy but towards the end of the treatment I needed to be catheterised due to prostatic inflammation induced by the Radiation.
Following the Radiation treatment I was left with no option but to have a TURP (bore job on prostate). My Urologist (an old friend) went as close to the wall of prostate as possible. That was 8 years ago and I have been able to void like a racehorse ever since.
Thanks for the posts on voiding.
I foolishly ignored this problem which became much worse the last two days.
Last evening I had to have a catheter inserted with a bag attached to my leg.
I initially voided over 1000 ccs. I now slosh when I walk.
I am staying a home this weekend and will see my doctor probably Monday.
Also taking Tamsulosin to help correct voiding problem,
I was told that when my bladder is normal-sized, this too will improve voiding.
I have initial urology appointment May 14, but trying to move that up now.
Moral of my story: I essentially ignored my voiding problem, ascribing it to old age (70s). That was stupid. No problem gets better by ignoring it; it just gets worse.
Again, thanks for the support I am getting. The worst thing I could do is isolate; I need to know there are others who have dealt with this -- and how -- and that people genuinely care.
