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Cancer: Prostate Message Board

Cancer: Prostate Board Index

[COLOR="DarkGreen"]Hi Mike,

Welcome to our club! (I know you would rather not be here, but that applies to all of us, so a hearty welcome anyway! :wave:

daff has provided good information and leads. I'll insert some additional comments in green to an excerpt of your post. Jim[/COLOR]

[QUOTE=golfman429;4047239]hello to everyone. I have received the word of my cancer with a glesaon score of 7 3/4 and a PSA of 5.5. I am 62 years old and in decent shape.

[COLOR="darkgreen"]daff mentioned that you need to get some additional facts, and here are a few of them. By the way, the Primer that daff mentioned is superb, and among other nice features, has a superb forms section where you can record your information.

You should know:

- How many biopsy cores were taken?
- How many were positive for cancer?
- What were the locations of the positive cores?
- What were the Gleason Scores of each positive core?
- What percentage of each positive core was cancer?
- Were there any unusual biopsy findings, such as likely seminal vesicle involvement or perineural invasion?
- If the information exists, what was your PSA velocity (the amount of increase) in the year leading up to your diagnosis? (Fairly recent research - the middle of this decade - has shown that to be a valuable clue in assessing the aggressiveness of the cancer, in addition to the usual clues. It helps to have old PSA dates and results handy.
- What was the stage of your cancer, in particular the results of the Digital Rectal Exam?
- What was the size of your prostate?
- If PSA density was calculated, what was it?

I'm glad to see that you have not had a bone or CT scan. Those scans are virtually useless for patients with case characteristics like yours, unless you count the value of adding money to the pockets of those who do the scanning. The AUA (American Urological Association) recommends against their use in such cases, unless the doctor has special reasons for thinking they are needed. There's a fairly recent thread about that on this board.

What I am trying to decide is having the surgery, after being told that there is a good chance of needing radiation afterwards anyway, or avoid the surgery and have the radiation.

[COLOR="darkgreen"]What was the basis for the doctor's telling you that there was a good chance that radiation would be needed? Such a comment from a doctor suggests he thinks there are clues indicating that the cancer has already spread beyond the prostate capsule - beyond the range of cure by surgery, but not beyond the range of cure by radiation. If the likelihood of spread is fairly high, you can do some additional staging work that would probably determine the issue.

I agree that it doesn't make much sense to have surgery if you are pretty sure you are also going to need radiation.

I have not spoken to anyone who has done radiation so I really am having a difficult time finding out about the effects.

[COLOR="darkgreen"]One of the best books is co-authored by a team at the Dattoli Cancer Center, and Dr. Dattoli is one of the world's experts in radiation for prostate cancer. The book is entitled: "Surviving Prostate Cancer Without Surgery - The New Gold Standard Treatment that Will Save Your Life and Lifestyle. It is excellent on all aspects of radiation, including side effects. The Primer also has excellent information on side effects. A book edited by three radiation experts from the Seattle Prostate Institute - Blasko, Grimm and Sylvester, also has excellent chapters on radiation.

If you want first hand research information, go to, a site we can use on this board because it is Government sponsored, and enter a search string like (without the quotation marks): " prostate cancer AND radiation AND side effects ". I just did that and, as of tonight, got 1,904 hits! :dizzy: :eek: Most papers have free abstracts, and if you click on the hypertext blue authors list, you will be able to read any abstract. Some papers have links to free copies of the entire paper. However, you might be overwhelmed by the information at this time. Give it a try and see how it feels. It's free - our taxpayer dollars hard at work!

I went to city of hope today, met with a surgeon and an oncology radiologist and now am more confused than ever, as both feel their procedure would be the most effective.

[COLOR="darkgreen"]A couple of weeks after my diagnosis I had an excellent second opinion consultation while on an anxious Christmas vacation back in late 1999 with Dr. Mark Kawachi of the City of Hope. They've got excellent doctors there. In fact, you are blessed to be in a mecca of excellence in prostate cancer treatment in the greater LA area.

The medical author of the Primer, Dr. Stephen B. Strum, used to practice there in Marina Del Rey. His practice continues under his former partner Dr. Mark Scholz and Dr. Richard Lam. All three are closely associated with the Prostate Cancer Research Institute (PCRI), which has excellent publications for patients (used to be located on Century Blvd. near LAX; may still be there).

I mention this because PCRI is sponsoring the latest edition of the series of National Conferences on Prostate Cancer, with Dr. Scholz as the moderator. It is being held at the Marriott Los Angeles Airport Hotel on September 12 -13, which is timely for you. These conferences bring together leading experts in various fields of prostate cancer, and I cannot recommend them highly enough. I've travelled from Virginia to two of them: Long Beach in 2000, and Burbank in 2003. I've also commuted to two that were held in the Washington, DC area. It's great to stay at the hotel and enjoy the company of fellow survivors, but commuting works too.

Experts this year that you might be particularly interested in include Duke Bahn (expert in staging, and cryosurgery, practicing in Ventura near you I believe), John Blasko (one of the pioneering Seattle experts in radiation, especially brachytherapy, and a research collaborator with Dr. Dattoli), Dr. Brosman (who I believe will present surgery), David Heber (from UCLA, noted researcher and author, will probably talk about nutrition), Dr. Lam and Dr. Scholz (expert medical oncologists specializing in prostate cancer and especially experts in hormonal blockade), Dr. Mark Moyad (noted for his reporting about nutrition and prostate cancer), and Dr. Charles Myers (an expert medical oncologist specializing in prostate cancer, with awesome expertise in nutritionand lifestyle tactics for prostate cancer, and a patient with a challenging case himself treated with IMRT, seeds, hormonal blockade, and even lymph node surgery, doing very well at the ten year point).

By the way, Dr. Myers has written a second book on Prostate Cancer that uses golf as the analogy - basically, figure out where the ball lies, and play it as it lies. It's an outstanding book and an easy read: "Beating Prostate Cancer - Hormonal Therapy & Diet." Since you are into golf, you would probably relate well to his analogies. I'm sure that he and his staff will have copies to sell at the conference, but they are also available through the usual sources.[/COLOR]

I was told that if I do the radiation first, and it does not get rid of all of the cancer, I may not be a candidate for surgery after that and if I did have surgery after the radiation, I would certainly have ED for the rest of my life and have incontenance as well. NEED SOME FEEDBACK PLEASE.

[COLOR="darkgreen"]daff's comments are right on target. Radiation was not always that reliable in eliminating cancer from the prostate itself, but for years now that has not been the case: in this current era, competent radiation is going to eliminate cancer from the prostate just as effectively as surgery, and it has the great advantage of being able to reach well beyond the prostate, especially for those few mm beyond that often cover the furthest excursion of the cancer :D. In other words, you really don't need surgery if you have radiation. This has been well established by research, but some surgeons still use the old stories to steer patients toward their specialty :mad:. On the other hand, if the cancer is clearly contained in the prostate, surgery would be a fine option and you would be unlikely to need follow-up radiation. Hope that helps.[/COLOR]


[COLOR="darkgreen"]As daff urged, hang in there and keep learning. It's tough at first :dizzy: :eek: :confused:, but you will begin to see things more clearly and will gain confidence. It can take some time. Using myself as an example, I'm pretty savvy now, but when I was diagnosed, I did not know there was such a thing as a DRE and I thought that the top score for a PSA test was 10.

Take care,

Jim :wave:[/COLOR]

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