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You should certainly consider Active Surveillance as a possibility for now, but continue to monitor your PSA every three or six months to get a more complete trend. Don't allow your doctor to pressure you into any immediate treatment plan until you feel comfortable with your options. Please keep us informed of your progress.
1. If you are considering active surveillance, run the genetic markers from polaris or oncotype. Ask your urologist or oncologist to order them so you have an idea how much risk you would be taking if you decided on active surveillance.
2. Request a prostate Prostate mpMRI to see other suspicious areas involved and the extent.
3. You might consider a second read of the biopsy slides, to confirm the grade.
4. You indicated the gleason grade is 7. is 3+4 or 4+3?
The above information will give you more data points so you can understand the full extent of what you are dealing with.
I would also obtain a copy of the pathologist's report, and doctors notes from medical records.
Now to the main question of "should you get a second opinion"
The above data will pretty much confirm the diagnosis, but where the second or third opinion comes in is if you decide on a treatment option, you should view multiple physicians.
For example, for surgery, interview at least a couple of surgeons who have prostate cancer surgery experience. For radiation, same thing. Radiation therapy involves different types external and internal radiation, and you may need to interview several radiologist oncologist with the different types of radiation therapy they offer.
Get recommendations from friends, family, or people you trust. Check out their experience, credentials and successes.
Consider places known for their treatment of prostate cancer. There are a lot of good places out there.
I met with the urologist today to talk about treatment options and here's what he said:
First, my stats:
My age: 63
PSA: 3.2 (3 years ago: 1.6)
2 of the 12 samples showed cancer: 1 spot had 5% cancer, the other 30%.
Stage: 1 (The doctor didn't want to apply a number to it and preferred the term "early" but said technically it would be "1" -- or maybe "2")
Gleason: 7 (1 spot was 3+4 at 80%/20%, the other was 4+3 at 20%/80%)
Cancer is "localized"
Treatment recommendations: Surgery or radiation.
I was hoping to go on active surveillance, but considering my Gleason, he didn't think that was a good idea. And while he is a surgeon, he didn't push me toward surgery, but said the decision was up to me.
So, now I'm wondering if I should get a second opinion? Also, if I decide to move forward with treatment, what type would be best?
Steve; Second opinions never hurt. My opinion only here but a Gleason 7 case is not going to stay the same or go away. Don't panic but do not let it have its way. It will never be easier to get rid of than right now. The longer it has to mature and grow, the harder it will be to treat it with good results. I say this not to scare you but to help you make the right decision for yourself. Do your homework, examine your priorities and options and proceed accordingly. You need to know yourself, if you would rather avoid the side effects of aggressive treatment by fighting it passively and hoping for the best or if you want to have every chance of getting rid of it by aggressive treatment which will come with the side effects. Only you can decide what is best for you. Again, my opinion only but, take care of it now as it will need attention at some point anyway. Hope I haven't overstepped my bounds here by expressing opinions. E-mail me if you have questions. Jon R.
As part of your research effort you may find the following book by Bob Marckini helpful: "You Can Beat Prostate Cancer..."His chapter on the newly diagnosed for treating PCa is usually of particular interest to the newly diagnosed. Although this book is nearly ten years old much of the information remains relevant.
In general the more research you undertake at this point ( be sure to include up to date material) the more likely you will be to make a good decision for yourself. Your research will also enable to ask good questions of the various clinicians you are bound to encounter as you proceed.
Best wishes Don O.
I am generally aware of this procedure but have not developed an opinion on its advisability. By talking to others who have undergone this procedure you are off to a good start.
As you probably know there is considerable CyberKnife data on Google. Another resource would be this site. Click on Survivor Stories and narrow your choice to CyberKnife listings.
Keep us posted.
I agree wholeheartedly. I actually went with my third opinion, which was Bob Markini's suggestion, from his book which had just come out, that recommended Proton Radiation. My first urologist was a surgeon who recommended the 'gold standard', surgery. So I postponed my decision for awhile as I was moving north to Tn. and knew I would find a new urologist. I did, and his recommendation was surgery, as he too was a surgeon. So I began to wake up and did some research. I got Bob's book and went to an oncologist in Oak Ridge who informed me of the procedure, Proton Radiation, and who recommended the group at the Univ. of Florida in Jacksonville. Needless to say, now, at 10 years distance, I feel it was a pretty good decision.
In short, it was the logical decision, as my cancer was still contained. But, I also decided to get a copy of Dr. Patrick Walsh's book, a surgeon, which included drawings of just what was involved in the surgery he did, and it was scary, obviously. The proximity of all the vessels and the nerves, and the fact that we're all just a little bit differently made..... well, I started trying to guess the odds of success in this environment. The result was the decision to not do the surgery, but to apply for Proton Beam Radiation at Univ. of Florida in Jacksonville, Fl..
And as my most recent update today shows, I'm sitting here with a 0.08 reading, right near the bottom of the chart.
Also, I suggest keeping a graph of the PSA scores, which will provide a powerful quick statement of one's current status at any moment.
Power to us..... I know how hard it is to keep up here at this site, and when I learned that I was cancer-free, it was even less frequently that I showed up. Now I have more time, as I'm retired with little to do. Power to us old farts......
Well, I got a second opinion today from a long-time urologist in the area, who thought we could simply observe things for awhile and have my PSA checked from time to time. He said he has a number of Gleason 7 patients (even with a 4+3 like myself) who are on active surveillance.
That being said, I will probably move forward with treatment this fall, but atleast I don't feel a sense of urgency to have something done "tomorrow."