Can DNA tests determine if the cancer is high risk?

I do not agree that aunt beanie's comment is excellent. In particular I take issue with her comment that her moto is " better out than in". This is not true with respect to prostate cancer. It does not behave like other cancers such as High grade lung cancer.

For those who are new to this site, " high grade" ( say 4+5) does not mean it WILL spread from the prostate. It means that it is more likely to spread and to spread quicker than intermediate grade (3+4), but factors like the patient's age and PSA history come into play. For instance, say the PSA has doubled in a year, THEN I would endorse surgery.

Unlike treating most other cancers, "getting it out" will not always improve a patient's quality of life.

Yes, I think radiation is wrong for my age.  Won't be doing it.  Thanks, David

I agree with Tybeeman (and we don't agree often...lol) you should not consider radiation unless it is a last resort option. 7 of 12 core samples would indicate there is a lot of cancer. This is one of the times I would say a prostatectomy is your best option.

I would recommend an MRI to see how many areas of concern are involved and even more important at this point...get a bone scan to make sure it has not spread. If it is still localized then prostatectomy is best choice in my opinion. If it has spread, then radiation is your best choice because you will have to have radiation treatment anyway so you don't need to do both.

However, based on Gregs results, I think he has MUCH better options available to him than a prostatectomy.

thank you but I choose to have the surgery because I don't want anything hanging around and knowing that I have cancer im my body I wouldn't feel very comfortable or confident that it's just not going away eventually to me is going to get it worth in my opinion with time again this is only my opinion

I'm a little nervous but my schedule surgery is December 7th nervous but confident

Good luck and I wish you well and a speedy recovery.

Greg,

Barney is right, I would recommend that you also get a full body scan before you do the radical prostatectomy. It is unlikely that the cancer has spread based on your biopsy results but if it has, a prostatectomy will not rid you of your prostate cancer. Again, not likely but it's a fast easy test and you can have the results within a day or two.

I still support your decision if you want to have a prostatectomy as everyman must make up his own mind of what's best for him. However I would just like to strongly encourage (almost beg) you to consider talking with Dr. Scionti (who did my procedure) before you go under the knife. Your situation is almost a mirror image of my situation earlier this year.

A prostatectomy will cause you to have incontinence, ED (for 1 to 2 years), and a shorter penis and sometimes deformed erections. Therapy and recovery is long, stressful and the people I have talked with say when they did get somewhat back to normal, it is not the same, and never as good as it was.

As I said, my case is almost identical to yours (actually you have less than I did) and I chose the HIFU procedure. It wasn't cheap $25k so I got a second job and I'm still paying it off. But I had an erection the very next morning after my surgery (which wasn't comfortable as I had a catheter but it was nice to know he still worked). To this day, I have no ED, no incontinence and the little general is the same size or maybe slightly bigger than he was before. I don't know this for a fact, but he just seems slightly bigger and all I can figure is the enlarged prostate was putting pressure on the urethra and pulling my penis inward. I wouldn't suggest this procedure to make your penis longer...lol. But having gone through the experience, I can highly recommend it for anyone with only one or two areas of cancer (still contained in the prostate). For me, I can honestly say I am better now than before my procedure as the symptoms of an enlarged prostate are also gone. I empty my bladder, I sleep through the night, and I can pee like a horse...Ok, maybe not like a horse...lol, but way way better than before the procedure. It's like it never even happened!

With HIFU, it KILLS the cancer and then also a margin around it to make sure they get it all and then your body flushes the dead cells out. It is also repeatable and does not disqualify any other procedures (including prostatectomy or radiation) should you decide to pursue that course of action down the road.

You (all men facing prostate cancer) CAN NOT take the word or opinion of one urologist. My urologist (an expert in his field) told me I would not qualify for HIFU and said my only option was prostatectomy. But he was wrong! I'm in better shape and state of mind now than I have been in over a year.

Dr. Scionti will look at you medical records and tell you if you qualify or not at no cost. You have nothing to lose and so much to gain. I am not affiliated with the HIFU industry or Dr.Scionti in any way so my motivation is only for your best outcome and well-being. I hope you don't mind me sharing my experience with you.

I'm not sure where you are located, but an FDA advisory panel refused to sanction it here after testing. They concluded that

"Results showed that high-intensity focused ultrasound was not highly effective. Nearly one in three prostates treated with HIFU tested positive for cancer in biopsies taken two years after treatment. It also posed a high risk of side effects, with more than half of the men treated with high-intensity focused ultrasound experiencing erectile dysfunction, urinary retention, incontinence, or other health problems".

Doctors around here will not even consider it.

Hi Rick,

I'm in the USA. FDA has approved HIFU in the USA just over a year ago and all recent reports have shown it to be successful. It has been available in other countries for close to 15 years and as they have improved the procedure (as they do with all procedures as they learn more about results) the side effects have gone down to almost zero. Of the last 80 procedures from Dr. Scionti, he claims zero incontinence or ED effects and I am one who can attest that to be true. I'm the type of person who would warn others if I had a bad experience as I wish no I'll will to anyone. But I can say this procedure has been a game changer. All current information has shown HIFU to be very effective. If you can produce something (current) that shows otherwise then post it.

When I tried to discuss other treatments with my specialist, he only gave me 2 options, radiation or surgery and dismissed all other treatments. 

There is not a lot of options where I am as far as doctors go so I pretty much had to make a decision as to what to do as my PSA levels were climbing and the biopsy showed cancer (from 4 to 9.1 in a year and a half). 

My brother had the surgery about 2 1/2 years ago and he is fine now. No ED  or incontinence and my neighbour is the same after about 3 years. 

I was told that if I tried radiation and it did not work, it would be a lot riskier to do the surgery so I opted to go that way. The lymph nodes were clear so the specialist is pretty sure I am now cancer free. I'll get tested in another month to be sure. dbcriss is still young and should bounce back quick.

Hey Rick,

I did some checking. The information you quoted is really old and very outdated regarding HIFU. All current information and results are much more positive regarding the procedure.

Radiation therapy in my opinion should be a last resort. Radiation limits future options and makes a prostatectomy nearly impossible. HIFU leaves ALL OPTIONS AVAILABLE. As a matter of fact. HIFU is also one of the preferred options if radiation therapy fails.

HIFU is not for everyone, I believe in dbcriss case a prostatectomy is the correct choise (but only after a bone scan confirms the cancer has not spread).

I can not comment regarding your situation. But if you are happy with your choice and results then great and I support your decision 100%. I just want men to know what they are in for. My urologist tried to sugarcoat the side effects and didn't disclose everything unless I brought it up. At the time of my consultation I didn't know about a shorter penis and funny thing is he didn't mention it.

It's pretty much a known fact that doctors only recommend what they are familiar with and poo poo anything that doesn't put gas in the Mercedes and food on the table.

Every mans situation is unique to him and Everyman must make must decide what is best for him but he can only do that if he has all the information and knows all the options available to him. There is almost nothing worse that to hear someone regreat the decision he made because they just took the doctors recommendation and he didn't know all the options available to him.

Truly, the only thing I wish for all men who face this horrible situation is to make their decision only after they know all the facts and all the options that are available to them.

Sometimes radiation is the best choice, sometimes a prostatectomy is best, sometimes it's HIFU and sometime active surveillance is right. But no one should make a decision until they have all the information and most importantly... NO ONE SHOULD LET any ONE DOCTOR tell them what is best for them. Every man should Seek several opinions before deciding.

Greg,

ES makes a very good point, not made by anyone else, including me. Please see more than one urologist. Every urologist will sell you his product be it radiation, open surgery etc. When you meet two or more you'll soon deduce that some have more experience in the same product eg surgery, or more experience in different therapies eg proton, HIFU, Brachy etc.

Don't limit yourself to just one urologist. Any procedure to tackle PCa is a big deal.

I think my urologist was the same in that if I did not ask a specific question then I would get no information. My visits typicaly lasted less than 5 minutes with him. He was not well liked at the hospital either, but all agreed he is a brilliant surgeon. When my results came back positive, he just said "You have cancer, it's agressive and it has to come out now".

2 weeks later it was done.

Wow Rick,

I am sorry you were dealt with so harshly. I still think, based on what you have posted about your situation, that a prostatectomy was the right choice. Also, even if your surgeon had no bedside manor at least he was considered brilliant at surgery. I would take a brilliant surgeon with poor bedside manor over a good or mediocre surgeon who shows compassion any day. There is a direct correlation (regardless of the procedure) of how well a man recovers from his procedure and minimizes side effects based on the skill level of his surgeon.

I believe dbcriss (based on his results) has made the right choice and I would be the first to encourage him to move forward (after a bone scan to make sure the cancer has not metastasized). I would also encourage him to check the experience level of his surgeon. Ask the surgeon directly how many prostatectomy procedures he has done and how many he does each month. What kind of results does he get and how does he expect recovery ( including side effects) to go. Is he planning to save the nerve bundles?

I hope Greg is reading this because he needs to do the same thing.

We all need to stick together because no one else is looking out for us.

The doctors want to make money.

The insurance companies don't want to spend money. And we are caught in the middle.

For anyone reading this post:

1) When confronted with prostate cancer, don't panic. In most cases, there is time to do research.

2) Be your own best advocate!

3) Get an MRI so you know where the cancer is. (Insist on 3T MRI)

4) Get a whole body bone scan or some other test that will tell you if the cancer has spread to other areas or not.

5) Research ALL possible options for your specific case.

6) Know ALL the possible side effects of any procedure you are considering and realistic recovery times.

6) DO NOT take the advice of just one doctor and DO NOT let him tell you what you DON'T qualify for.

7) Talk to the doctors who perform the procedures you are interested in and let them tell you if you do or do not qualify.

8) Ask to speak to some patients they have operated on. (For past patients privacy, they will not give you this information but will give your name and number to a past patient to call you.)

I'm not a doctor and this is just my opinion based on my cancer experience and research. I have no "skin in the game" as to what procedure someone chooses. My one and only goal is that when a man chooses a procedure, "when the dust settles" no one has regrets about their decision and can say to themselves, "I made the right choice for me".