<p>A very dear friend of our family has just been diagnosed with early stage prostate cancer. He has asked us to help him evaluate options…and I know people here can help with great information and leads. </p>
<p>He can travel anywhere to get access to the best doctors/treatments.</p>
<p>It is debatable in the medical community whether prostrate cancer should be treated. It depends a lot on the patients age. It is an extremely slow growing cancer and most men will die from some other disease first.</p>
<p>Also, most men will get prostrate cancer if they live long enough…it’s widespread and common.</p>
<p>So, your family friend is very lucky in the sense that if he has any cancer, prostrate cancer is the one to have.</p>
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<p>To begin with it’s prostate, not prostrate, cancer. And only some cases are slow growing. Others are very aggressive and grow quickly. There is no debate that the fast-growing cancers should be treated unless the patient is at a very advanced age. The problem is there is no definitive test to distinguish fast growing from slow growing cancers. It’s more a case of determining odds based on imperfect data. Hence the dilemma and debate.</p>
<p>Prostate cancer kills nearly as many men in the US each year as breast cancer kills women. So it’s not a trivial problem or minor cause of disease and death. And dying of metastatic prostate cancer is not a pretty death. So it’s not a disease you should ignore. </p>
<p>There are several options based on the patient’s age, life expectancy,and whether it has already begun to spread. And there are several treatment paths should treating it be the best option. I suggest your friend consult a urologist - they specialize in prostate cancer and can offer the best information and treatments.</p>
<p>Thank you, coureur for quickly typing what I was about to say! Only a doctor specializing in prostate cancer treatment can give your friend a qualified opinion on what his treatment options are. Not to scare your friend, prostate cancer CAN be very aggressive (a leading researcher in my field died of prostate cancer only a year or so after being diagnosed) and will require aggressive treatment approaches. All the best to him, OP.</p>
<p>My husband was diagnosed with an aggressive prostate cancer that was caught early. He consulted with his own well- respected physician and then with the team at Dana Farber. He felt that he then has the information he needed to make the decision. Strongly suggest OP that your friend find a doctor or center with whom he is comfortable, do some research and then choose treatment plan. My husband’s was aggressive enough and at a surprisingly young age - such that our son has been told to begin testing at 35. Best to your friend.</p>
<p>A friend has been diagnosed with prostate cancer, but he is also undergoing treatment for a cardiac condition which has forced him to postpone treating the prostate to his great relief.</p>
<p>I think whether to treat it or not depends on your dr and on your PSA results. I’ve heard of doctors who don’t even test for it.
[Prostate</a> Cancer Surgery Fails to Cut Death Rate in Study - Businessweek](<a href=“Bloomberg - Are you a robot?”>Bloomberg - Are you a robot?)</p>
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<p>Not really. It is a combination of PSA and biopsy results. PSA basically indicates the need to take biopsies. 25 years ago, a urologist might take a single “core” sample. Nowadays they will probably take five or more on each side of the gland. (Prostate cancer can be diffuse, or can be present in several areas in the gland, so too few samples mean it can be easily missed.) The sample are then examined for presence and stage of cancer, and evaluated on the Partin scale, developed at Johns Hopkins using a sample of thousands of patients. The Partin scale will suggest what treatment is indicated.</p>
<p>IMNSHO, there is a lot of hooey talked right now that discourages men from acting. My father died of prostate cancer. He was in his 80s, but was in great health otherwise. When he first had a significantly elevated PSA, they did a single biopsy and found nothing. Three months later, they repeated the process and this time found the cancer. He had surgery, but it had already spread to the seminal vesicles. Nowadays, the surgery would have been followed up with targeted radiation because of that, and he probably would have been spared the intervening years of bone and bladder cancer, not to mention side effects of Lupron treatment. I have little doubt that he would be alive and enjoying life today, living happily with my 89-yr-old mother. My husband had surgery for prostate cancer a few years ago. He was in his mid 50s, and had a tumor that was at the very edge of the gland, along his bladder. There is basically no way to determine precisely where the tumor is ahead of time. The Partin scales provide guidance, and in his case they suggested surgery. He did not have a tremendously high PSA. The “wait and see” approach would likely have had him being treated for bladder cancer by now. </p>
<p>I read about that study in the Times, and the article made all kinds of vague statements about “early stage” cancer without ever defining the term. Just being confined to the gland is NOT a sufficiently detailed description. It appeared that they randomly assigned men to surgery or watchful waiting without regard to staging their cancer using biopsy. Big whoop: most likely most of those men would not have been recommended for surgery anyway.</p>
<p>Oh, and if I am not mistaken that study concerned itself only with the 5-year death rate and included only 731 men. I’d go with the Hopkins scales, myself.</p>
<p>I recommend joining one of the cancer support websites, such as Inspire
[Us</a> TOO Prostate Cancer Support Community - Inspire](<a href=“http://www.inspire.com/groups/us-too-prostate-cancer/]Us”>Prostate Cancer)
or Cancer Survivors Network (American Cancer Society)</p>
<p>Good luck.</p>
<p>DH had an elevated PSA for years. He’s had three biopsies, all negative. Not fun, but thankfully he doesn’t have cancer. </p>
<p>If it were my father or husband, we’d be at Memorial Sloan Kettering.</p>
<p>My husband had prostate cancer three years ago. He ended up having it removed. Things are different now, but I am estatic to still have my best friend around.</p>
<p>For prostate cancer, much of the problem is that the usual tests (PSA, biopsies) are not particularly reliable in determining the minority of aggressive cancers versus the majority of less aggressive cancers (which are extremely common in older men, probably almost universal among those who reach 90 years old). Treatment is not trivial, and carries significant risk of quality of life issues (e.g. incontinence), so it is not something that is an easy choice to do for any cancer that is found. I.e. dozens of men will have to be treated for every one whose life is saved, and many who are treated will have quality of life issues afterward.</p>
<p>My dad was diagnosed with prostate cancer about 15 years (or so) ago. He opted for the radioactive seed implant and has been very happy with the results. If I remember correctly, he had surgery and a minimal recovery time. </p>
<p>Many of his friends that opted for prostate removal ended up with incontinence. He has often mentioned how glad he is that he didn’t opt for that. He goes every year for his PSA test and so far - great!</p>
<p>This is a subject close to my heart - my dad died from it twenty years ago after going through a miserable end-game following surgery. I’ve had my share of enlarged prostates and high PSAs, green light laser procedures and biopsies, but nothing malignant. </p>
<p>As far as CA, I’ve known acquaintances who’ve had surgery, and those who’ve had Brachytherapy (radioactive seeds implanted), and all doing quite well. The funny thing is that my urologist doesn’t favor surgery in most cases, and another well known one recommends it much more than the radiation. If you are destined to have CA, this seems to be one of the ones to wish for.</p>
<p>thanks for all of the quick responses…I am passing along everything I am learning, and also the link to the support group.</p>
<p>I echo the other posters about researching treatment options enough to make an informed decision. We weighed different surgical options (traditional vs. robotic da Vinci surgery) and compared length of recovery time vs. surgical outcome statistics. The da Vinci robotic surgery dramatically reduced the recovery time as well as improved the surgical outcome because it is more precise and less invasive. (Btw, aggressive CA was diagnosed at >45 during annual checkup without an elevated PSA, so don’t assume that elevated PSA is a reliable indicator.)</p>
<p>A good place to start research is the [National</a> Cancer Institute’s website](<a href=“http://www.cancer.gov/cancertopics/types/prostate]National”>http://www.cancer.gov/cancertopics/types/prostate). Another helpful resource is the [Prostate</a> Cancer Foundation](<a href=“PCF-Curing Together | PCF | Prostate Cancer Foundation | Prostate Cancer Symptoms”>PCF-Curing Together | PCF | Prostate Cancer Foundation | Prostate Cancer Symptoms) in Santa Monica, which was founded by Michael Milken. It offers information about current research and clinical trials, as well as alternative therapies.</p>
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<p>That’s the problem with PSA – it is prone to both false positives (resulting in unnecessary invasive biopsies and treatment) and false negatives (resulting in not detecting aggressive cancers that need treatment). Unfortunately, there does not seem to be anything better now.</p>
<p>This is all good information. I will keep it in mind if H ever goes for a checkup.</p>
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<p>We came to the opposite conclusion. Recovery time may be slightly less, but outcome is not better in the long run. </p>
<p>Prostate cancer is basically invisible. One cannot look at the gland and determine which parts are cancerous and which are not. Imaging does not tell you. The borders of the gland are also less than well-defined in some areas. Everyone wants to perform the “nerve-sparing” type of surgery if at all possible. But if the tumor[s] extend to the nerve bundles, which run along the outside of the gland, it is not safe to spare the nerve bundle because that will mean leaving cancer cells behind. The best way to tell whether the cancer is there is by feel: the tumor feels gritty or bumpy, while normal tissue does not. The DaVinci/robotic surgeon is incapable of making this distinction. The expert surgeon using the traditional method–which these days involves a MUCH smaller incision than in the past, a much faster procedure, and a much faster recovery–can make this distinction. S/he can feel the tumor. There is also a lot of information out there about how many procedures a surgeon must perform before s/he attains maximum expertise, and this includes those using robotic technology.</p>
<p>After doing a lot of reading on the subject, and meeting with and discussing the subject with both traditional and robotic surgeons, we concluded that the MUCH more expensive robotic surgery was less effective that traditional surgery if performed by a GOOD surgeon.</p>
<p>Agree with Consolation and same choice made here, which was good given the findings both during the surgery and with the pathology report. Regardless of procedure choice, prostate removal causes longterm effects that one must prepare for and are manageable with good communication and support.</p>
<p>Consolation, thank you for all of this information to consider. I am passing all of this on.</p>