Re: New Member - Dave W

[Guest guest]

Hi Dave,

I am sorry to hear about your diagnosis. ABOVE ALL DO NOT

PANIC AND RUSH INTO TREATMENT. Your cancer has

probably been growing in your body for several years. It will not kill

you any time soon. It is your responsibility to make the treatment

decision, but it should be a well informed decisions. Before you

make a treatment decision that you will have to live with for the

rest of your life, get a second opinion from a doctor who does not

specialize entirely doing surgery. Take the time to learn all your

options. Have several PSA tests and make a chart. The PSA

will correlate fairly closely to the cancer activity. Do not rush

into any therapy if you have a moderate or insignificant cancer.

It will not kill you immediately- you may be much better off

just doing watchful waiting or a better term is Active Surveillance.

Again, make a chart and have several PSA tests. Look for any

upward trend and especially doubling time. You might also

change your diet and way of living if necessary.

I had my prostate removed in 1992- but we did not have as many

options at that time. I would not choose surgery today. I believe

that there are better options. If I had it to do over, I would choose

brachytherapy, (seed implants or HDR). Of course there are

other options such as External Beam Radiation or IMRT, Proton

Beam radiation (it is one of the better therapies, but expensive, some

insurance may not cover it), Cryo Surgery and soon we will have High

Intensity Focused Ultrasound (HIFU). HIFU may be the least invasive

of all, but still not FDA approved in U.S. Many are now choosing

Laparoscopic or Da Vinci robotic assisted surgery to remove

the prostate. But it has the same unpleasant side effects of

the Retropubic Radical Prostatectomy (RRP). For advanced

PCa, there is hormone ablation and several regimens of chemo.

No matter what therapy one chooses, there are always some side

effects, No matter who does it or how it is done, removal of the

prostate has side effects, some more pronounced and unpleasant

than others.

You are wise to do a lot of research. One reason not to have surgery

is because, for me, sex was never the same after my prostate was

removed. The prostate and the seminal vesicles manufacture almost

all of the ejaculate. During orgasm, the prostate squeezes down and

forces the semen out. This is a part of the pleasure of an orgasm.

One may still be able to have an orgasm after a RP, but it may take

a lot more stimulation.

Many men who have surgery are impotent afterwards. There are

nerves on each side of the prostate that control erectile function.

These nerves are difficult to see and quite often they are severed

or severely damaged.

Another side effect of RP is that many men lose some length and

girth afterwards. Several studies have been done on this subject.

Go to www.google.com and search for Loss of Penile Length and

Radical Prostatectomy.

Many men are also incontinent for some time after surgery because

the primary bladder valve is intimately connected to the prostate. It

is often damaged. Most men do recover urinary continence by

doing Kegel exercises which strengthens the secondary valve below

the prostate. Unfortunately, a few men never regain continence. A few

of these men have to have an Artificial Urinary Sphincter implanted

in order to control their urinary output.

But even if they do learn to control normal urinary functions by doing

Kegel exercises for this valve, when they try to have an erection or

become sexually aroused, this valve will open and they may have

leakage. This valve has always opened during sexual activities

and no amount of Kegel exercises will cause it do otherwise.

The primary valve is not involved in brachytherapy, or seed

implants so there is little or no incontinence.

The impotence rate is also very low. Some men will still have an

ejaculate, though it may be much less in volume. Some men are

even able to father children after brachytherapy. After a RP, one may

be able to have sperm aspirated from the testes and used to

impregnate a woman. But it is a difficult procedure, is expensive and

may not always be successful. If a man thinks he may want to father

children after a RP, he should consider banking some of his sperm.

For more information, you can read my book below my signature. Over

20 MDs and several survivors contributed to it. I wish you all the bestAubrey Pilgrim, DC (Ret.) Author ofA Revolutionary Approach to Prostate Cancer-Read the original book for FREE at: http://www.prostatepointers.org/prostate/lay/apilgrim/Read new edition for FREE at http://www.cancer.prostate-help.org/capilgr.htmDr. E. Crawford is co-author of the revision

Hello All,I was just diagnosed with Prostate Cancer last week and am exploringtreatment options. I'm 46 years old and first had a PSA test a yearago. Since then I've had 3 more PSA tests and then a Biopsy.12/06 - PSA 7.53/07 - PSA 5.9, Free PSA 15%6/07 - PSA 6.39/07 - PSA 5.8, free PSA 15%All DRE's negative, prostate not enlarged12/07 - Biopsy was positive on 4/4 on the left side and 1/4 on theright. The one positive sample on the right had only 5% cancerouscells. Ultrasound was normal.Gleason Score 3+3I've had some back pain this fall which I think is due to an injurybut I'm scheduled for a Bone Scan tomorrow. Even though the data showsalmost a 0% chance of it spreading to the bone for someone with my PSAlevels, Gleason Score and T1C I'm still very nervous.I'll be meeting with my Doctor on Friday and am also planning to visitSloan Kettering for a consultation.I'll keep you posted.Regards, DaveSee AOL's top rated recipes and easy ways to stay in shape for winter.

[Guest guest]

Hi Dave,

I believe that you have come to the right place to get some real down

to earth advice. I think that you will probably get a lot of

responses to your request, and I advise that you read them all with a

lot of thought.

Keep in mind that there are a lot of different circumstances that

each individual has to face in regard to their own diagnosis and the

associated decisions that they make in regard to their treatment.

Here is the results from my diagnosis on Oct 31, 2007;

• Age – 53 (turned 54 in Nov 2007)

• PSA is 3.83

• Gleason's Grade - 3+3=6

• One biopsy core (Right mid) was diagnosed with carcinoma,

which was less than 10% of the tissue submitted.

• One other biopsy core (Left apex) had a " high grade

parostatic intraepithelil neoplasia " (atypical cells, otherwise

called pre-cancer cells).

• All other biopsies benign.

From all that I had read, and from my consultation with my Urologist

and Surgeon, my understanding was that my prostate cancer was a " low

grade " and it had been diagnosed in an early stage.

My Approach to Treatment –

My approach to treatment, and decision for which treatment to use,

was primarily based upon what I believed to be the surest method of

curing the cancer. In other words, my primary motives were not based

on avoiding surgery, pain, or the possibility of incontinence or

impotency. Sure, I wanted to come away with the fewest side effects,

but primarily I wanted the surest method of curing the cancer, and

remaining cancer free for the rest of my life.

I believed that at my age, I would have a life expectancy of 20 plus

years. I wanted to have the best chance of living that long with the

least fear of reoccurrence, even if I had to live all that time with

some unpleasant side effects.

My thoughts were that with my early stage of cancer that the chances

were very good that the tumor would be located totally within the

prostate gland. Therefore, after looking into many options, I came

to the conclusion that having surgery was going to be the best method

for eradicating the cancer. I also thought that using the newer

robotic surgery would provide me with the best recovery options, as

well as the best chance to reduce the possibility of " long term "

incontinence and/or impotency.

For me, the Robotic-assisted Laparoscopic Radical Prostatectomy

provided me with a far less invasive procedure then the Radical

Retropubic or Radical Perineal open surgery. Surgery provided with

the most effective way for my doctor to view the actual site of the

cancer and allowed him to do exactly what he felt was necessary to

get it all out. Also, the pathologist would be able to examine the

entire prostate gland, once it is removed, and confirm the original

biopsy results. They would also be able to examine the surrounding

tissue and determine if the cancer had spread outside the prostate.

For me, this would allow me the best way for my doctor, or other

specialists to determine if additional treatments are necessary.

Expected Side Effects –

After the operation, I fully expected some short term leakage after

they removed the catheter, and probably this may continue for some

time. According to what I have studied, and from what my surgeon has

confirmed, my chances for long term incontinence issues are expected

to be about a 1% chance or less.

I also fully understood that after surgery, I would not have exactly

the same sexual experience as before the surgery. In my specific

case, I believed that the chances were very good that my surgeon

would be able to spare both the right and left nerve bundles that

control erectile functionality, and I hoped to continue to have a

near normal sexual life going forward.

My next few statements are meant to be totally honest about what I

expect to be different in regard to my sexual experiences after

surgery based upon my research, and based upon talking to other men

that have gone before me. If you are not comfortable with a graphic

discussion of sexual behavior, please just skip down to

the " Treatment Options " section.

The first impact is that I fully expected was that my erections MAY

not be as hard as they were before surgery, at least for the first

few week or months, and this may only be a short term effect. Some

people make it sound like if you have surgery, it is a given that you

will have long term impotency issues. I have talked to men that have

had both the open surgery as well as those that have had the robotic

surgery. Many men recover to have good erections, and many times

they are nearly, if not as fully as hard of an erection as they had

before the surgery. This has a lot to do with your age, other health

issues, if you are already experiencing any ED related issues, as

well as the experience and accuracy of the surgeon that you chose.

Regardless of how hard your erection is going to be, many men say

that they still have great orgasms even if they no longer have an

erection. Also, there are many treatments to help with the quality

of an erection if there are any difficulties.

Another expected impact was that I would no longer have ejaculate

when I climax. When they perform the prostatectomy, they also remove

the seminal vesicles, therefore, no more seamen. I also understand

that my orgasm may not be exactly the same as before, primarily

because there will no longer be a prostate. This means that during

orgasm, I will not feel the prostate contract to cause an

ejaculation, nor have the sensation of the ejaculate going through my

penis and squirt out the end. Just thinking about how that felt

before surgery, I had to think that sexual relations would be

somewhat different then it was before. Regardless, many men say that

their climax feels just as good as it did before they had surgery and

you get used to not having any ejaculate come out. Also, some men

have even told me that before surgery, when they had sex and they had

an ejaculation, then that was all there was to it, but after surgery,

they may not have ejaculate, but at the same time they found out that

they now can have multiple climaxes. Well that is an interesting

trade off… I have no idea how many men that happened to though.

Treatment Options –

As I performed my research in trying to make my decision, I gathered

the following information from various places and have tried to

provide this documentation to help give others some basic information

to get familiar with the various treatment options.

There is a lot for you to think about when choosing the best way to

treat or manage the cancer. The treatment you choose for prostate

cancer should take into account:

• your age and how long you can expect to live

• any other serious health problems you may have

• the stage and grade of your cancer

• your feelings (and your doctor's opinion) about the need to

treat the cancer

• the chance that each type of treatment will cure your cancer

(or provide some other measure of benefit)

• your feelings about the side effects common with each

treatment

Below I have listed many of the treatments that are available for

treating your prostate cancer, along with expected side effects so

that you can read more about them.

Specifically, in regard to my case, here are my thoughts on active

surveillance (watchful waiting, or expectant management), External

Beam Radiation Therapy (EBRT), Proton Beam Radiation Therapy (PBRT),

Cryosurgery and even Hormone Therapy. I did not believe that these

were MY best long term options. Even though some of them have had

impressive results, there is no evidence that they provide any better

results in eradicating the cancer. In fact, I believed that I would

have a higher possibility of recidivism, and over a 20 plus year life

expectancy.

I believed that the External Beam Radiation Therapy, and Proton Beam

Radiation Therapy, especially Brachytherapy, the treatment in which

tiny radioactive " seeds " are implanted in the prostate appear to be

treatments with promise, after the surgery option. These treatments

also have the potential for reduced impacts up front, and primarily

for the short term, which I mean over the next 5 years or so.

Regardless of the reduced up front, short term benefits, ALL the

radiation treatments either have as much risk, if not even a greater

risk, for impacts over the long run, which I mean as 5 years or more

after being treated. EBRT and Brachytherapy may have the same long

term impacts for incontinence and impertinence, but it will probably

start impacting you 3 to 5 years later and then those impacts could

even get worse from there. Even though PBRT has the potential to

kill the cancer that you have now, unfortunately, because the

prostate remains, it leaves the window fully wide open for the cancer

to return down the road. I was also made aware that if the cancer

does return latter, unfortunately, and as was confirmed to me by Loma

Medical Center, you are no longer a candidate for another round

of PBRT. Therefore, I would still need to consider another option

for treatment at that point. Another consideration is that my

understanding is that all the radiation treatments reduce your

chances for having surgery as a back up option, whereas, if there is

a failure with surgery, and you need further treatment options, the

radiation treatments are still available as a back up salvage option.

I fully believe that for someone else, and especially for those men

that are much older then me, or possibly for men that have a more

advanced cancer then me, and possibly for some men that may have

other health risks beyond the prostate cancer, and for those people

that are so afraid of surgery and/or the potential side effects that

they simply can not make that choice, then one of these radiation

treatments may even be the most preferred option for them. I

personally think that one of these options are a better option then

taking the approach of " doing nothing " .

Watchful Waiting (Expectant Management)

Because prostate cancer often grows very slowly, some men (especially

those who are older or who have other major health problems) may

never need treatment for their cancer. Instead, their doctor may

suggest an approach called " watchful waiting " (also called " expectant

management " or " active surveillance " ). This approach involves closely

watching the cancer (with PSA testing) without using treatment such

as surgery or radiation therapy. In my opinion, the younger you are,

if you are otherwise healthy, and if you have a low grade of cancer,

this is not the best choice. Also, you never know if you may be one

of those men that have a fast-growing, more aggressive cancer, which

could get out of control while you are just waiting around. Some men

choose watchful waiting because, in their view, the side effects of

strong treatments outweigh the benefits.

Surgery

A radical prostatectomy is the " gold standard " treatment for younger

men with a low grade of prostate cancer. I believe that there are

very good reasons why the mainstream medical professionals, including

most urologists that treat prostate cancer, present surgery as the

most preferred primary treatment option. They believe that it

provides the best option for a " cure " . It is done most often if it

looks like the cancer has not spread outside the prostate. The entire

prostate gland and some tissue around it are removed.

Robotic-assisted Laparoscopic Radical Prostatectomy

An even newer approach is to do LRP remotely using a robotic

interface. The surgeon sits at a panel near the operating table and

controls robotic arms to perform the operation through several small

incisions in the patient's abdomen.

Risks and side effects of radical prostatectomy

The risks with this surgery are like those of any major surgery and

can include problems from the anesthesia, a small risk of heart

attack, stroke, blood clots in the legs, infection, and bleeding.

Your risk depends, in part, on your overall health, your age, and the

skill of your doctors. The main possible side effects of radical

prostatectomy are lack of bladder control (incontinence) and not

being able to get an erection (impotence). These side effects can

also happen with other kinds of treatment.

Radiation Therapy

Radiation therapy is treatment with high-energy rays (such as x-rays)

to kill or shrink cancer cells. The radiation may come from outside

the body (external radiation) or from radioactive materials placed

directly in the tumor (brachytherapy or internal radiation).

Radiation is sometimes used as the first treatment for low-grade

cancer that has not spread outside the prostate gland, or has spread

only to nearby tissue. It is also sometimes used if the cancer is not

completely removed or comes back (recurs) in the area of the prostate

after surgery. Cure rates for men treated with radiation seem to be

about the same as for men having surgery. If the cancer is more

advanced, radiation may be used to shrink the tumor and provide pain

relief.

External Beam Radiation Therapy (EBRT)

This treatment is much like getting a regular x-ray, but for a longer

time. Each treatment lasts only a few minutes. Men usually have 5

treatments per week in an outpatient center over a period of 7 to 9

weeks. The treatment itself is quick and painless. Today standard

EBRT is used much less often than in the past. Newer techniques allow

doctors to be more accurate in treating the prostate gland while

reducing the radiation exposure to nearby healthy tissues. These

techniques appear to offer better chances of increasing the success

rate and reducing side effects.

Proton Beam Radiation Therapy (PBRT)

Proton radiation treatment differs from standard radiation therapy.

If given in sufficient doses, conventional radiation therapy

techniques will control many cancers. Because of the physician's

inability to adequately conform the irradiation pattern to the

cancer, healthy tissues may be damaged with radiation. Consequently,

a less-than-desired dose frequently is used to reduce damage to

healthy tissues and avoid subsequent unacceptable side effects. The

characteristics of proton beam therapy enable the physician to

deliver full or higher doses while sparing surrounding healthy

tissues and organs. The side effects of proton therapy, though

identical to those of conventional x-ray, are greatly diminished,

because the proton beam is so well focused that damage to normal

tissues is reduced. Another consideration for this treatment option

is that it is not readily available except for specific medical

centers, it is regularly not covered by insurance, it requires two or

three months time commitment and usually results in many thousands of

dollars of out of pocket cost.

Possible Side Effects of External Beam Radiation Therapy

The possible side effects below relate to standard external radiation

therapy, which is now used much less often than in the past. The

risks of the newer treatment methods mentioned above are likely to be

lower.

Bowel problems: During and after treatment with external beam

radiation therapy, you may have diarrhea, sometimes with blood in the

stool, rectal leakage, and an irritated large intestine. Most of

these problems go away over time, but in rare cases normal bowel

function does not return after treatment ends.

Bladder problems: You might have trouble with having to urinate

often, a burning sensation while urinating, and blood in your urine.

Bladder problems persist in about 1 out of 3 patients, with the most

common problem being the need to urinate often.

Urinary incontinence: Although this side effect is less common than

after surgery, the chance of incontinence goes up each year for

several years after treatment.

Impotence: After several years, the impotence rate after radiation is

about the same as that of surgery. It usually does not occur right

after radiation therapy, but slowly develops over a year or more. As

with surgery, the older you are, the more likely it is you will

become impotent. Impotence may be helped by treatments such as those

listed in the section above, including erectile dysfunction

medicines.

Feeling tired: Radiation therapy may also cause fatigue that may not

disappear until a few months after treatment stops.

Lymphedema: Fluid buildup in the legs or genitals (described in the

surgery section of this document) is possible if the lymph nodes

receive radiation.

Brachytherapy (brake-ee-ther-uh-pee) (Internal Radiation)

In one approach (permanent or low dose brachytherapy), small

radioactive pellets (each about the size of a grain of rice) are

placed directly into the prostate. Sometimes these pellets are

referred to as " seeds. " Because they are so small, they cause little

discomfort and are often simply left in place after their radioactive

material is used up.

In another form of brachytherapy (temporary or high dose

brachytherapy), needles are used to place soft tubes (catheters) in

the prostate. A strong radioactive substance is placed in these

catheters for 5 to 15 minutes and then removed. You will stay in the

hospital for this treatment. Usually 3 brief treatments are given

over a couple of days. After the last treatment the catheters are

removed. Often this treatment is combined with external radiation,

given at a lower dose than it would be if used alone. For about a

week after this treatment you may have some pain in the area between

your scrotum and rectum, and your urine may be reddish-brown.

Possible Risks and Side Effects of Brachytherapy

If you have pellets that are left in place, they will give off small

amounts of radiation for several weeks. Even though the radiation

doesn't travel far, you may be told to stay away from pregnant women

and small children during this time. You may be asked to be careful

in other ways as well, such as wearing a condom during sex.

For about a week after the pellets are put in place, there may be

some pain in the area and a red-brown color to the urine. There is

also a small risk that some of the seeds might move (migrate) to

other parts of the body. Like external radiation treatment, this

approach can have side effects such as problems with the bladder and

bowel and impotence. But it may be that these occur at a lower rates.

Be sure to talk to your doctor if you have any of these side effects.

Often there are medicines or other methods to help.

Cryosurgery

This approach is sometimes used to treat prostate cancer by freezing

the cells with cold metal probes. It is used only for prostate cancer

that has not spread but may not be a good option for men with large

prostate glands. The probes are placed through incisions between the

anus and the scrotum. Cold gases are then passed through the probes,

which creates ice balls that destroy the prostate gland. Some type of

anesthesia is used during this procedure.

A catheter is also put in place (usually through the abdomen) so that

when the prostate swells (it usually does after this treatment) urine

does not stay trapped in the bladder. You will probably be in the

hospital for a day. The catheter is removed a couple of weeks later.

After the procedure, there will be some bruising and soreness of the

area where the probe was inserted. You may have some blood in the

urine for the first few days. Short-term swelling of the penis and

scrotum after cryosurgery is also common.

Possible Side Effects of Cryosurgery

There are benefits and drawbacks to cryosurgery. On the one hand,

because it is less invasive than radical surgery, there is less loss

of blood, a shorter hospital stay, shorter recovery time, and less

pain. But freezing can damage nerves near the prostate and cause

impotence and incontinence. These side effects may occur more often

than they do after radical prostatectomy. In addition, freezing may

damage the bladder and intestines. This can cause pain, a burning

sensation, and the need to empty the bladder and bowels often.

Compared to surgery or radiation treatment, doctors know much less

about how well the method works in the long run. For this reason,

most doctors do not include cryosurgery among the first options they

recommend for treating prostate cancer.

Hormone Therapy

The goal of hormone therapy (also called androgen deprivation) is to

lower the levels of the male hormones or androgens (an-dro-jens),

such as testosterone (tes-toss-ter-own). Androgens, which are made

mostly in the testicles, cause prostate cancer cells to grow.

Lowering androgen levels often makes prostate cancer shrink or grow

more slowly. Hormone therapy can control, but will not cure the

cancer. It is not a substitute for treatments aimed at a cure.

Hormone therapy is often used in the following situations:

• In men who do not have surgery or radiation as good treatment

options.

• For men whose cancer has spread to other parts of the body or

has come back after earlier treatment.

• It may be used along with radiation in men who are at high

risk of having the cancer return after treatment.

• Sometimes it is used before surgery or radiation to shrink

the cancer.

While hormone therapy does not cure the cancer, it can provide relief

from symptoms. Some doctors think that hormone therapy works better

if it is started as early as possible after the cancer has reached an

advanced stage. But not all doctors agree with this.

Because nearly all prostate cancers become resistant to this

treatment over time, some doctors use an on-again, off-again approach

(intermittent therapy). The drugs are given for a while, then

stopped, then started again. One advantage is that some men are able

to avoid the side effects (impotence, loss of sex drive, etc.) for a

time. Studies are now going on to see whether this new approach is

better or worse than giving the drugs constantly.

Types of Hormone Therapy

There are several methods used for hormone therapy. They involve

either surgery or the use of drugs to lower the amount of

testosterone or to block the body's ability to use androgens.

Orchiectomy (or-key-eck-tuh-me): Even though this is a type of

surgery (surgical castration), its main effect is as a form of

hormone therapy. In this operation, the surgeon removes the

testicles, where more than 90% of the androgens, mostly testosterone,

are made. While this is a fairly simple procedure and is not as

costly as some other options, it is permanent and many men have

trouble accepting this operation. Most men who have this surgery lose

the desire for sex and cannot have erections.

Orchiectomy can have serious side effects. These vary and depend on

the kind of treatment you are given. About 90% of men who have had

this operation have reduced or no sexual desire and have impotence.

Other side effects could include:

• hot flashes (these often go away with time)

• breast tenderness

• growth of breast tissue

• weakening of the bones (osteoporosis)

• low red blood cell counts (anemia)

• lower mental sharpness

• loss of muscle mass

• weight gain

• tiredness (fatigue)

• lower levels of HDL ( " good " ) cholesterol

• depression

Many of these side effects can be treated. Osteoporosis can be a

major problem because men who have it are more likely to develop bone

fractures. If osteoporosis develops, it should be treated. Exercise

is a good way to reduce fatigue, weight gain, and the chance of loss

of bone and muscle mass. Depression can also be treated with

medicines and/or counseling.

LHRH analogs (luteinizing hormone-releasing analogs): These drugs

lower testosterone levels just as well as orchiectomy. LHRH analogs

(or agonists) are given as shots, either monthly, or every 3, 4, 6,

or 12 months. Even though this treatment costs more and means more

doctor visits, most men choose this method over surgery to remove the

testicles.

Side effects are like those from the surgery (see above). Also, when

LHRH analogs are the first given, the testosterone level goes up

briefly before going down to low levels. This is called " flare. " Men

whose cancer has spread to the bones may have bone pain during this

flare. To reduce flare, drugs called antiandrogens can be given for a

few weeks before starting treatment with LHRH analogs.

LHRH antagonists: A newer drug, abarelix (Plenaxis®) is an LHRH

antagonist. It lowers testosterone more quickly and does not cause a

flare. But a small number of men are allergic to the drug. For this

reason it is only used for men who cannot take other forms of hormone

therapy. The side effects are similar to those of orchiectomy or LHRH

agonists (see above).

Abarelix is given only in certain doctors' offices. It is given as a

shot every 2 weeks for the first month, then every 4 weeks. You will

need to stay in the office for 30 minutes after the shot to make sure

you do not have an allergic reaction.

Anti-androgens: These drugs block the body's ability to use any

androgens. Even after the testicles are removed or during LHRH

treatment, the adrenal glands still make a small amount of androgens.

Anti-androgens may be used along with orchiectomy or the LHRH analogs

to provide combined androgen blockade (CAB), or total blocking of all

androgens produced by the body. There is still debate about whether

CAB is better than using the other treatments alone.

Anti-androgens can cause diarrhea, nausea, liver problems, and

tiredness. They seem to cause fewer sexual side effects than other

hormone treatments.

Other drugs: At one time estrogens (female hormones) were used to

treat men with prostate cancer. Because of side effects, LHRH analogs

and anti-androgens are now used. But estrogen or some other drugs,

such as ketoconazole (Nizoral®), may be used if other hormone

treatments are no longer working.

Debates About Hormone Therapy

Many issues about hormone therapy are not yet resolved, such as the

best time to start and stop it and the best way to give it. Studies

looking at these issues are now going on. If you are thinking about

hormone therapy, ask your doctor to explain which treatments will be

used and what side effects you might expect to have.

Chemotherapy (Chemo)

Chemo is the use of drugs for treating cancer. The drugs are often

injected into a vein. Some can be swallowed in pill form. Once the

drugs enter the bloodstream, they spread throughout the body to reach

and destroy the cancer cells.

At one time, chemo was not thought to work very well in treating

prostate cancer, but this has changed in recent years. In the past

few years, new drugs have been shown to relieve symptoms from

prostate cancer in men with advanced disease.

Like hormone therapy, chemo is unlikely to result in a cure. This

treatment is not expected to destroy all the cancer cells, but it may

slow the cancer's growth and reduce symptoms, resulting in a better

quality of life.

There are a number of different chemo drugs. Often 2 or more are

given at the same time for better effect.

Side Effects of Chemo

While chemo drugs kill cancer cells, they also damage some normal

cells and this can lead to side effects. The side effects of chemo

depend on the type of drugs, the amount taken, and the length of

treatment. They could include:

• nausea and vomiting

• loss of appetite

• hair loss

• mouth sores

Because normal cells are also damaged, you may have low blood cell

counts. This can cause:

• increased risk of infection (from a shortage of white blood

cells)

• bleeding or bruising after minor cuts or injuries (from a

shortage of blood platelets)

• tiredness (from low red blood cell counts)

Also, each drug may have its own unique side effects.

Most side effects go away once treatment is over. If you have

problems with side effects, talk with your doctor or nurse about what

can be done. There is help for many chemo side effects. For example,

there are drugs to prevent or reduce nausea and vomiting. Other drugs

can be given to boost blood cell counts.

I hope that this information is useful. I hope that it may be of

some help toward getting you started down the road in considering

which options are available, and which treatments may fit better into

your set of circumstances.

I wish you the best of outcomes with your treatment, regardless of

which you chose.

Ted G.

>

> Hello All,

>

> I was just diagnosed with Prostate Cancer last week and am exploring

> treatment options. I'm 46 years old and first had a PSA test a year

> ago. Since then I've had 3 more PSA tests and then a Biopsy.

>

> 12/06 - PSA 7.5

> 3/07 - PSA 5.9, Free PSA 15%

> 6/07 - PSA 6.3

> 9/07 - PSA 5.8, free PSA 15%

> All DRE's negative, prostate not enlarged

>

> 12/07 - Biopsy was positive on 4/4 on the left side and 1/4 on the

> right. The one positive sample on the right had only 5% cancerous

> cells. Ultrasound was normal.

>

> Gleason Score 3+3

>

> I've had some back pain this fall which I think is due to an injury

> but I'm scheduled for a Bone Scan tomorrow. Even though the data

shows

> almost a 0% chance of it spreading to the bone for someone with my

PSA

> levels, Gleason Score and T1C I'm still very nervous.

>

> I'll be meeting with my Doctor on Friday and am also planning to

visit

> Sloan Kettering for a consultation.

>

> I'll keep you posted.

>

> Regards, Dave

>

[Guest guest]

>

> Hello Dave my name is Mike I was diagnosed last January PSA went from

2-7 in 2 years chose radical prostatectomy after recieving doctors

advise. Gleeson's Grade 3+4=7, pt2c, NX, MX, G3 carcinoma involved

right and left apical and mid regions of the prostate and the right

base. No extraprostatic extension of tumor identified. Possible

lympovascular space invasion.

A great book to read that my doctor recomended for us was Prostate and

Cancer by Sheldon Mark's MD.

My doctor is a surgeon and an oncologist. He recommended RP over seeds

because he said you don't know if seeds get it all and the Robotic

surgury he doesn't like because he feels better going in there with

hands on so he can get a better look at whats going on. My incontinance

stopped about 3 weeks after catheter was removed. Oh by the way I had

surgury in March. I was told it could take up to 18 mos. to fully

recover. He feels he got all of the cancer we can only hope and pray.

Erections will be back soon I hope. And if not that can be taken care

of in many different ways. Good luck with your decision.

[Guest guest]

Hans,

Who was your robotic surgeon at s Hopkins?

Thank you.

Ted Meredith

--- Hans Van Schuerer wrote:

> Dave,

>

> You are wise to be pro-active. Thanks for sharing

> your stats. Please let us know how your Sloan

> Kettering Consult goes.

>

> I opted for robotic surgery 7/06 at age 56. Gleason

> 7, PSA 3.2. Post OP path report confirmed very

> aggressive cancer that was contained within the

> capsule. Margins were clear. PSA continues to

> remain <0.1. My primary goal of eradicating cancer

> seems to have been met.

> Drs at s Hophins give me 97% chance of being

> cancer free in 5 years, 95% chance of being cancer

> free in 10 years. Over all, pretty good odds.

> [brady Urology at s Hopkins has very informative

> website.]

>

> I believe that I'm fortunate to have DEMANDED a

> biopsy from a sluggish 'old school' urologist. [He

> is no longer a team member.]

>

> Every success.

>

> New Member - Dave W

>

> Hello All,

>

> I was just diagnosed with Prostate Cancer last week

> and am exploring

> treatment options. I'm 46 years old and first had a

> PSA test a year

> ago. Since then I've had 3 more PSA tests and then a

> Biopsy.

>

> 12/06 - PSA 7.5

> 3/07 - PSA 5.9, Free PSA 15%

> 6/07 - PSA 6.3

> 9/07 - PSA 5.8, free PSA 15%

> All DRE's negative, prostate not enlarged

>

> 12/07 - Biopsy was positive on 4/4 on the left side

> and 1/4 on the

> right. The one positive sample on the right had only

> 5% cancerous

> cells. Ultrasound was normal.

>

> Gleason Score 3+3

>

> I've had some back pain this fall which I think is

> due to an injury

> but I'm scheduled for a Bone Scan tomorrow. Even

> though the data shows

> almost a 0% chance of it spreading to the bone for

> someone with my PSA

> levels, Gleason Score and T1C I'm still very

> nervous.

>

> I'll be meeting with my Doctor on Friday and am also

> planning to visit

> Sloan Kettering for a consultation.

>

> I'll keep you posted.

>

> Regards, Dave

>

>

>

>

>

>

>

________________________________________________________________________________\

____

> Be a better friend, newshound, and

> know-it-all with Yahoo! Mobile. Try it now.

>

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

>

>

________________________________________________________________________________\

____

Be a better friend, newshound, and

know-it-all with Yahoo! Mobile. Try it now.

http://mobile.yahoo.com/;_ylt=Ahu06i62sR8HDtDypao8Wcj9tAcJ

[Guest guest]

Ted G. has taken a lot of time to explain his decision making process

for his own treatment. Thank's for sharing. I hope that most men can

and do go through this sort of process. Nevertheless he is wrong about

some things.

Ted makes dozens of statements about different protocols, benefits,

expected results and problems, etc. One of his descriptions in

particular, regarding PBRT reveals that he is not so knowledgeable

after all. I had PBRT and have studied the protocol, and have

experienced the results, so I know he is somewhat offbase. I'm left

wondering about the inaccuracies in his other descriptions.

[Guest guest]

To: aborden65

As someone new to the group and not yet selected a

treatment, it could be helpful to me if you would, in

your gentlemanly manner, describe where Ted G may not

have given complete information.

Thank you for your consideration.

Ted M

--- aborden65 wrote:

> Ted G. has taken a lot of time to explain his

> decision making process

> for his own treatment. Thank's for sharing. I hope

> that most men can

> and do go through this sort of process. Nevertheless

> he is wrong about

> some things.

>

> Ted makes dozens of statements about different

> protocols, benefits,

> expected results and problems, etc. One of his

> descriptions in

> particular, regarding PBRT reveals that he is not so

> knowledgeable

> after all. I had PBRT and have studied the

> protocol, and have

> experienced the results, so I know he is somewhat

> offbase. I'm left

> wondering about the inaccuracies in his other

> descriptions.

>

>

>

>

________________________________________________________________________________\

____

Never miss a thing. Make Yahoo your home page.

http://www.yahoo.com/r/hs

[Guest guest]

Yes. Dr Li-Ming Su. Hans

[ProstateCancerSupp ort] New Member - Dave W> > Hello All,> > I was just diagnosed with Prostate Cancer last week> and am exploring> treatment options. I'm 46 years old and first had a> PSA test a year> ago. Since

then I've had 3 more PSA tests and then a> Biopsy.> > 12/06 - PSA 7.5> 3/07 - PSA 5.9, Free PSA 15%> 6/07 - PSA 6.3> 9/07 - PSA 5.8, free PSA 15%> All DRE's negative, prostate not enlarged> > 12/07 - Biopsy was positive on 4/4 on the left side> and 1/4 on the> right. The one positive sample on the right had only> 5% cancerous> cells. Ultrasound was normal.> > Gleason Score 3+3> > I've had some back pain this fall which I think is> due to an injury> but I'm scheduled for a Bone Scan tomorrow. Even> though the data shows> almost a 0% chance of it spreading to the bone for> someone with my PSA> levels, Gleason Score and T1C I'm still very> nervous.> > I'll be meeting with my Doctor on Friday and am also> planning to visit> Sloan Kettering for a

consultation.> > I'll keep you posted.> > Regards, Dave> > > > > > >____________ _________ _________ _________ _________ _________ _> Be a better friend, newshound, and > know-it-all with Yahoo! Mobile. Try it now. >http://mobile. yahoo.com/ ;_ylt=Ahu06i62sR 8HDtDypao8Wcj9tA cJ> > ____________ _________ _________ _________ _________ _________ _Be a better friend, newshound, and know-it-all with Yahoo! Mobile. Try it now. http://mobile. yahoo.com/ ;_ylt=Ahu06i62sR 8HDtDypao8Wcj9tA cJ

Never miss a thing. Make Yahoo your homepage.

[Guest guest]

Great news... My bone scan came back negative as expected.

Dave

>

> Hello All,

>

> I was just diagnosed with Prostate Cancer last week and am exploring

> treatment options. I'm 46 years old and first had a PSA test a year

> ago. Since then I've had 3 more PSA tests and then a Biopsy.

>

> 12/06 - PSA 7.5

> 3/07 - PSA 5.9, Free PSA 15%

> 6/07 - PSA 6.3

> 9/07 - PSA 5.8, free PSA 15%

> All DRE's negative, prostate not enlarged

>

> 12/07 - Biopsy was positive on 4/4 on the left side and 1/4 on the

> right. The one positive sample on the right had only 5% cancerous

> cells. Ultrasound was normal.

>

> Gleason Score 3+3

>

> I've had some back pain this fall which I think is due to an injury

> but I'm scheduled for a Bone Scan tomorrow. Even though the data shows

> almost a 0% chance of it spreading to the bone for someone with my PSA

> levels, Gleason Score and T1C I'm still very nervous.

>

> I'll be meeting with my Doctor on Friday and am also planning to visit

> Sloan Kettering for a consultation.

>

> I'll keep you posted.

>

> Regards, Dave

>

[Guest guest]

To: aborden65> As someone new to the group and not yet selected a

treatment, it could be helpful to me if you would, in

your gentlemanly manner, describe where Ted G may not

have given complete information.

Thank you for your consideration.

Ted M

I am going to put my two cents in here. My spouse had cryosurgery

several months ago.

Ted's statement:

" But freezing can damage nerves near the prostate and cause

impotence and incontinence. These side effects may occur more often

than they do after radical prostatectomy. "

There is a very small chance of incontinence with cryosurgery--less

than with surgery. Warm saline solution is circulated through the

urethra and bladder throughout the freezing and thawing cycles, thus

preserving normal function.

" In addition, freezing may damage the bladder and intestines. This

can cause pain, a burning sensation, and the need to empty the

bladder and bowels often. "

Here we are talking about the old freeze it all mode of cryo that

first started many years ago. Certified cryosurgeons and updated

technology preserve both bladder and bowel function more completely

when the treatment is primary. There is slightly greater risk of

damage when it is salvage for another mode of failed treatment, such

as radiation or surgery.

" Compared to surgery or radiation treatment, doctors know much less

about how well the method works in the long run. "

True enough, especially for focal cryoablation, where only the part

of the prostate is frozen that has cancer. This has not been the

way Pca treatment has been handled and it will take years to

determine its efficacy.

" For this reason,most doctors do not include cryosurgery among the

first options they recommend for treating prostate cancer. "

Most doctors are not certified in the procedure so they will not

recommend it.

You can find out more about cryosurgery at prostatepointer.org.

Carol

aborden65 wrote:

Ted G. has taken a lot of time to explain his

decision making process

for his own treatment. Thank's for sharing. I hope

that most men can

and do go through this sort of process. Nevertheless

he is wrong about

some things.

Ted makes dozens of statements about different

protocols, benefits,

expected results and problems, etc. One of his

descriptions in

particular, regarding PBRT reveals that he is not so

knowledgeable

after all. I had PBRT and have studied the

protocol, and have

experienced the results, so I know he is somewhat

offbase. I'm left

wondering about the inaccuracies in his other

descriptions.

>

>

>

>

_____________________________________________________________________

_______________

> Never miss a thing. Make Yahoo your home page.

> http://www.yahoo.com/r/hs

>