Decision on prostate cancer treatment?

My brother is 54 yrs old and was just diagnosed with prostate cancer with a Gleason score of 5. His PSA was 4.25. The biopsy showed that he only had traces of cancer on the right side of his prostate and it was limited to that area. He is in excellent health and very active, and has not shown any signs of any urinary problems.





He is considering the treatment option of "watchful waiting". What are your thoughts on this vs possibly robotic surgery? Some doctors prefer surgery when the patient is this young. Thanks for your inputs on this.

Decision on prostate cancer treatment?
With a Gleason Score of 5 and a PSA of 4.25, "Watchful Waiting" or "Active Surveillance" as it is also called, is a valid choice. prostate cancer is a very slow growing cancer. Many men rush into treatment as soon as they are diagnosed because they fear that the cancer has spread outside the prostate and they want to contain it. Your brother has time and his age on his side. Use this time to become informed about the disease, the treatments available, and the side-effects of those treatments. Active Surveillance requires careful monitoring of PSA levels and further biopsies to determine the rate of growth of the tumor, do not make the mistake of ignoring the problem. As long as the tumor is organ confined and slow growing there is no need to take action.





Robotic Surgery is an excellent choice for your brother given his age and his general good health, when he is ready for it. In the hands of a very skilled surgeon the outcome can be superior to the traditional surgical approach. The key is finding a surgeon who has done hundreds of these procedures, the learning curve for Robotic Assisted Surgery is very high, and the best results with minimal side-effects are with the Doctors who have the most experience.
Reply:Prostrate cancer discovered at a relatively young age may be a fast growing type. Brachytherapy (radioactive seed implantation) is a less invasive treatment compared to radical surgery, is equally effective, and has far fewer side effects. Report It

Reply:DR V, thanks for both of your responses. Both are good inputs and will be considered. My brother's initial step is to get a 2nd opinion from another pathologist to confirm that they see the same evidence of cancer that was seen by the 1st pathologist. Report It

Reply:I had my urologist send my biopsy slides to Sloan-Kettering in NY for a second opinion. They are very good in the field of PC.





For me the results came back as the same. It was reassuring, and I felt better able to go on with researching a best treatment. Report It

Reply:Is there any prostate cancer in your family? I think there are many other tests that should be ran with that level of PSA. My first question is: does he have an enlarged protate? A simple urine test can determine if there is a urine tract infection. Either of these can account for a higher level of PSA, which is benign, but the latter can also be cancerous. Once this is decided, the doctor needs to rule out an infection of either the prostate, urethra, bladder or kidneys by using ultrasound. Once these have been ruled out, a biopsy can be performed, usually with a needle.





At this point, you should be more informed and know what to do next. I wouldn't let it go, I would have tests ran and if need be, get the biopsy.
Reply:I am a little older than you brother, and my PSA runs "slightly " high,


and I have been told, one year I might develop prostate cancer.


My feeling just might be ,. "operate and get it the hell over with."
Reply:Watchful waiting is usually done in the case of older men where surgery may be risky due to other health problems. For a 54 yr old surgery is probably a better option. As you mention robotic surgery this is a good option because the recovery would be faster than traditional open surgery. Talk to the surgeon and find out about the surgery, the risks vs. benefits before you make a decision. Good luck!
Reply:Urologists are surgeons and will push robotic surgery. That is old school. Look into seed implantation. Do not do watchful waiting, in my opinion.





This is where I went:


http://www.dattoli.com





I was diagnosed at 49 with no symptoms.
Reply:I was 59 and elected the surgery. The PSA is only valuable if you have a base line. Mine went from 1.5 to 4.5 in a year. You mentioned Gleason of 5 mine was 8. The Biopsies did not show all of my cancer. After they removed it they found cancer in more areas that the biopsies missed. I had the surgery last July and it was one of the best decisions I ever made. Recovery time is a pain. However any treatment other than surgery gives it a chance to spread. If it's contained in the prostate and you remove it it's gone. I've had 2 PSA test since surgery and both were 0 Yeaaa. Doctor said has to stay 0 for 4 years to be cancer free/
Reply:First: what is the stage of his cancer? Is it T1c? Or is it palbable? What previous surgery has he had? Careful with robotic. There's a lot of hype out there. Focus on the surgeon, not the machine. And you're doing a good thing by supporting him. It's important and helps with the anxiety.
Reply:Print and give to bro.Tell bro to watch and wait.Do not rush into any treatment. What is suggested below is almost a cure.Do the exercises as suggested and you will notice improvement in the third (maybe second) PSA test onwards.


Cancer hates oxygen and cannot live in a high-oxygen environment.If you want to supplement the medical treatment you receive(or not receive) with some alternative therapy then this is for you. You need to help your body to build up your immune system.The breathing exercises - pranayam is a holistic approach creating extra oxygen supply in the body and will slowly help with the health problem.Do the pranayam to see the benefits.Build up your timing slowly and after four weeks at the suggested maximum duration you will start to notice benefits gradually.


What is known:Do the pranayam and reap the health benefit.How it works in the body is not known – but people may build their own theory.


The small print: Keep doing pranayam after you are better for minimum 30 minutes a day for rest of life to maintain health.





People who have been treated successfully, should do pranayam as well, as there is a chance of recurrence.


Monitor your conditions/results regularly and it will help you and others observe the progress.List existing conditions with any levels/numbers time spent on toilet seat,weight,BP,dental/eye/ear conditions including eye prescription numbers,sleep problems,blood results etc.





The pranayam techniques:


Bhastrika - Take a long deep breath into the lungs(chest not tummy) via the nose and then completely breathe out through the nose.Duration upto 5 minutes.





Kapalbhati -(Do it before eating) Push air forcefully out through the nose about once per second. Stomach will itself go in(contract in). The breathing in(through the nose) will happen automatically. Establish a rhythm and do for upto 30 minutes twice a day.(Max 60 min/day) Not for pregnant women. Seriously ill people do it gently.





Anulom Vilom - Deep Breath-in through left nostril keeping right nostril closed


then - Breath-out through right nostril keeping left nostril closed


then -Deep Breath-in through right nostril keeping left nostril closed


then - Breath-out through left nostril keeping right nostril closed


and repeat this cycle for upto 30 minutes twice a day(maximum 60 min/day).





Bhramri Pranayam -Close eyes. Close ears with thumb, index finger on forehead, and rest three fingers on base of nose touching eyes. Breathe in through nose. And now breathe out through nose while humming like a bee.


Duration : 5 to 10 times





Only by doing you will benefit and will feel good that you can do something to help the body.Copy and print this to improve your technique and stay focused.This is simplified pranayam for everyone and you do not have to go to classes to learn. This is for life, unlike short term classes where you do it in the class then stop when classes are over.