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Cancer: Prostate Message Board

Cancer: Prostate Board Index

Hi Anne,

Welcome to the board. :) You and your husband must be reeling from that diagnosis, especially since he is young. :confused:

You are going to one of the leading institutions for treating prostate cancer in the world, one especially known for its surgery (not so hot for hormonal therapy/androgen deprivation therapy, in my opinion). I had several early second opinion consultations and tests/scans done there myself. In fact, I initially chose surgery, though fortunately the doctors at that institution promptly steered me away from that for my case that was then highly aggressive.

That "stage 6" is almost surely not "stage" but "Gleason 6." (There is no stage 6 - only up to 4). Gleason 6 is actually a good kind to have. If there is no cancer with a higher Gleason score that has been missed, which fairly often happens in a regular biopsy unaided by what is called "multiparametric" MRI (just described in another post), then the risk of metastasis is virtually zero unless fresh and more aggressive cancer develops separately. That said, the mass of Gleason 6 cancer is capable of growing and spreading locally. Sometimes, up to 20% in one major research series of men, it takes more than a century for this kind of cancer to double in size. While most Gleason 6 cancers will double in size in a considerably shorter time, true Gleason 6 cancer is often best treated by what is known as "active surveillance." The leading center your husband is going to also has one of the world's best known programs for research on active surveillance. My hunch is that doctors at that center would be expert in determining what would be best for your husband.

It would help to know the usual key numbers for your husband's cancer. They would be: the Gleason score (for example, 3+3=6), the number and percent of positive biopsy cores, whether there was mpMRI guidance of the biopsy and the resulting PI-RADS score plus comments, the stage (usually mainly determined by the DRE (digital rectal exam), his latest PSA and date, previous PSAs and dates, and any imaging. You and your husband are entitled to these reports, and you should ask for and keep copies of them if you do not have them.

Often wives just want to get this new and unwelcome problem out of their lives, and surgery appeals for that reason. However, it, as well as other sound options, do involved risks of side effects. It is not a cake walk. Those side effects are well worth it if treatment is necessary, but they are grounds for regret if treatment is not really necessary. It's important to do this right. Radiation these days is as good as surgery, in fact better in some cases, though less advantageous in others (such as when a man already has urinary problems). There are some other options, such as focal therapy for appropriate cases, but those options are little used in the United States and lack a long record of success. Some, such as HIFU for whole gland prostate treatment, look suspiciously bogus in view of research.

Here's some critically important information for your and your husband's peace of mind: for all major cancers, prostate cancer has the best long-term outcomes, and those outcomes are stunningly good! :cool: While back in the seventies one third of diagnosed prostate cancer patients were not alive at the 5 year point since diagnosis, now that number is over 99% - virtually 100%. You may be thinking that that is good, but not so reassuring for a young man. Well the five and ten year numbers are also stunning: again virtually 99% at ten years (compared to age-matched peers for all these numbers), and within a percent of 95% at 15 years (havenít checked the exact number on a table Iíve misplaced). :angel: Of course, most of us are going to do fine for the rest of our lives, but they donít publish statistics for 20 years and beyond. The men who are still up against it, survival wise, almost always have distant metastases at the time they are diagnosed. Unfortunately, only about 30% of them make it to 5 years, though the number is climbing (and I expect it to climb more rapidly in the near future). Also, the side effect burden has become lighter for many of us.

Good luck to you!:angel:

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