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Tough Decision

Recently diagnosed with Gleason 7 (3+4) and have been doing research for the past few months. I had a biopsy that found prostatic adenocarcinoma in three of ten cores, all on the left side.

Less than 0.1cm of a 1.5cm core
Less than 0.1cm of a 0.8cm core
0.3cm of a 1.4cm core

My PSA was last tested at about 4.7. My prostate is normal size with no indication of enlargement during DRE.

I am otherwise healthy and active. Looks like I have a very tough decision to make. I have narrowed it down to either Radical Prostectomy (hoping my age and health will ensure a complete recovery) or Active Surveillance.

From what I have read here a Gleason 3+4 is sometimes considered for active surveillance as well.

Not sure of next step. Should I get another PSA test to see if any of the lifestyle enhancements and supplements have helped? Perhaps an MRI? I need to call back my urologist as I had put my surgery on hold while doing research and getting other opinions.

I know there is no right answer. Only statistics!

Re: Tough Decision

Michael:
It is indeed a very tough decision. Please consider getting yourself a copy of Bob Marckini's book : "You Can Beat Prostate Cancer..." His chapter on the advantages and disadvantages of several methods of treating PCa is usually of particular interest to the recently diagnosed.FTh This book is readily available, an easy read and well worth its modest price. Although this book is nearly ten years old at this point much, if not most, of the information remains relevant.

Best wishes Don O.

Re: Tough Decision

Hi Don,

I have about a dozen books I have read since being diagnosed positive from Patrick Walsh's classic to newer alternative treatments. Not sure if I have this one but thanks for the suggestion!

Regards,

Michael

Re: Tough Decision

Hi Michael and welcome,
Yes you do have a tough decision to make, but rest easy, as many of us on here have also been down that path. You are just starting out on you journey while most of us are seasoned travellers.

On reading your post it would seem that you are deciding between RP and AS. True your stats just sneak you into the AS category, if you so choose. But could you provide a few further details, namely your age and previous PSA readings and dates when they were taken. From that would would be better informed to offer you an opinion, albeit a no expert medical one.

best wishes
john

Re: Tough Decision

Hi John,

Thanks so much for your reply. I know you post and reply often on this site so appreciate your input.

I am 55 years old and thanks to my GP have been monitoring my PSA since late forties.

I need to visit the office to get the exact details but I would say that my PSA rose from normal to a high of 4.7 within a spam of about 2 years.

Will get exact stats when I can.

Regards,

Michael

Re: Tough Decision

Fine Michael, please do that. The PSA velocity is what we need to know.

best wishes
john

Re: Tough Decision

Hi John,

This is all I have. Long period between the first two though.

Oct. 26 2011 2.85 ug/l
Jan. 09 2014 4.54 ug/l
Apr. 15 2014 4.72 ug/l
Jan. 08 2015 4.80 ug/l
Apr. 23 2015 4.30 ug/l

I have some other thoughts I will post later when I have time.

Regards,

Michael

Re: Tough Decision

Michael,

You have very low volume cancer. That's good. You have low gleason. That's good. Regarding the MRI....You should get a 3T-MP MRI and if no hidden tumors are found you could choose AS safely. You also have another choice. You could choose to have FLA (Focal Laser Ablation). Since all of you disease is on one side you qualify for this procedure. It has virtually no lasting side effects. If you have recurrence you can have another FLA or standard RP or Radiation.

Fred

Re: Tough Decision

Hi Feed,

Thanks so much for your reply. I have been looking at some of these newer treatments and many are not available in Vancouver Canada but have an option to go to Toronto for treatment as my sister lives there.

I think I should contact a clinic there and send my pathology reports to see what they say.

Thanks again,

Michael

Re: Tough Decision

Here are some links to information. Hope this helps you - best wishes - Rick

This the site for Clinical Trials and you will find Focal Brachytherapy in Vancouver. When you get on the site go to "Clinical Trials" , then go to "Search Clinical Trials" at the bottom of the page, and type in "Focal Brachytherapy". This should bring you to Dr. Jim Morris's study in Vancouver.

http://inclinicaltrials.com/prostate-cancer/01830166.aspx (Clinical Trial in Vancouver, B.C. for Focal brachytherapy - Dr. Jim Morris @ VGH Cancer Center @ 604-877-6000 (loc 672770)
________________________________________________________________________________________________________________________________________________________________________________________________________
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080850/ (Focal Laser Ablation)
http://www.ncbi.nlm.nih.gov/pubmed/23440319 ( MR imaging-guided focal laser ablation for prostate cancer: phase I trial. )
http://www.prostatecentre.ca/index.php/research-and-clinical-trials/clinical-trials/treatments (Focal Laser Ablation @ Princess Margaret Hospital (Cancer Center) in Toronto)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723876/ (Focal Therapy for localized prostate cancer)

*****************************************************************************************************************************************************************************************

Re: Tough Decision

Wow thanks Rick,

I just left a message to see if I am eligible.

Regards,

Michael

Re: Tough Decision

I left a message and Dr. Jim Morris called me personally. Interestingly, I just left my name and number but I guess he has access to my medical records. He thanked me but said I would be ineligible as there is one criteria I do not meet. The cut-off is cancer in max of two cores but I have three (even though small, less than 1mm) Understandably he can't change the criteria mid-term.

He also said that places that offer focal therapies as a standard of care are clutching at straws (or money) as we do not have enough evidence yet.

Re: Tough Decision

Hi Michael. Glad I could be at least of some help with a suggestion anyway. Too bad the number of cores thing though. I only got one call from the good Dr. Morris (a nice fellow by the way) when they had the results of my 38 core biopsy. since then the Dr. did a "whole gland" brachytherapy for me. 145 seeds. Maybe one of the Ontario things might work out. Well, got to go. best wishes - Rick
P.S. It seems to me a matter of simple logic that any treatment that allows as little trauma and bodily disturbance as possible, which is the very heart and goal of Focal Therapy, should be far superior to the so-called Whole Gland whatever? therapy. And it amazes me that the powers to be are so reticent about this thing called Focal therapy! I'm really surprised (well maybe not! nor should I be!)that this can't be recognized and understood and that more funding isn't being made available for this type of therapy. Lord knows there are certainly enough willing participants.

Re: Tough Decision

Well I have concluded my research and have decided to go for surgery (radical prostatectomy) as watchful waiting seems too risky, radiation does not appeal, focal therapy still unproven.....

Hopefully with my young age, great health, small localized tumour site, no symptoms, negative DRE and experienced surgeon I will have a good recovery.

Good luck to all!

MB

Re: Tough Decision

Michael B.
Best wishes.
Don O.

Re: Tough Decision

Good choice. I was with a Gleason score 3+3=6 when I was 43 years old back in 2002. Had my surgery and been fine. My PSA never reached zero. It average .2 for many years. I think doing surgery first is the way to go, and if that fails, radiation, and if that fails, chemo. Each protocol one can buy more time. Good luck.

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