Prostate Cancer diagnosis with Gleason score of 7

[Brenda A]

I am writing concerning my 68 year old dad.  He was diagnosed with prostate cancer two weeks ago and has started Casodex, and Flomax.  He is starting hormone shots next week.  His Dr. has advised radiology and the seed implants.  He had a CAT scan, Bone Scan, and blood work that showed no signs of the cancer spreading.  His Gleason was a 7 based on a 3+4 rating.  If the cancer has not spread, I am wondering why the Casodex and homone therapy? All my research indicates that hormone treatment is only for cancer that has spread.  He is really struggling with trying to decide on a treatment.  He does not want surgury as he is worried about incontinence.  My parents have been married for 45 years and are very close and this has just devestated our large family.  We are all very close and just want some advice in making the best decision to keep our dad healthy and happy as long as possible. Thank you so much for your time and any advice.

[Ash Tewari, MD, M.Ch.]

What is his PSA? Is he in good physical condition?

There are three treatment options for patients with prostate cancer-watchful waiting, radiation therapy and surgery.

Many factors such as age, Serum PSA values, biopsy results and spread of  have to be taken into consideration while deciding treatment

Recent publications undergoing surgery for clinically localized prostate cancer may have a better survival compared to those electing radiation or observation.

Those with locally advanced cancer.i.e. when cancer has spread locally to the organs around the prostate are better treated with radiation therapy.

Those patients with cancer that has metastasized i.e spread to distant organs are treated with hormonal therapy.

For localized prostate cancer,surgery has a better survival advantage as compared to either watchful waiting or radiation .  Surgery can be either traditional open surgery or minimally invasive such as laparoscopic and robotic.Incontinence is a problem with both radiation as well as with surgery.
Robotic radical prostatectomy is a minimally invasive surgery for removal of the cancerous prostate. The advantages are decreased post-operative pain , decreased blood transfusions and better patient comfort. Robotic prostatectomy achieves excellent results in terms of cancer control, continence and potency.

This answer is not intended and does not substitute for medical advice- the information is for patient education only

[TWOCENTCIGAR]

How funny!

Ask this monkee Urologist what happens after the 10 hour robot procedure (because the learning curve is 70 procedures) what happens after surgery when they realize the positive margins?  That being the cancer left behind!  Obviously his hospital spent the 1.2 million on the robot and so it must get used!  Instead of providing you with clinical advice, he rather promote a modality of economic interest!  Its a sad place/topic in US medicine!

It all depends on WHO is delivering the procedure! A "radical" is exactly that and I would never let anyone cut out my prostate! Just ask NY Yankee Manager Joe Torre that! He had surgery and upon sending the specimen to the pathology lab, they learned he had positive margins and therefore required radiation! Not to mention the incontinence and impotence rates associated!  Why did Mayor Gulliani have seeds and EXBRT?  Because it works!  Don't believe me, just read his book!

I would elect prostate brachytherapy with a stranded technology! I'd also reccomend a premier Radiation Oncologist and hospital! (ie. Mt. Sinai of New York City and Dr.'s Cesserati or Stock) Where do you live?

Providing of course he's an ideal candidate for treatment! Active surveilance never hurt anyone as MOST men die with prostate cancer and RARELY from it!

Hope this helps!

[Ric1]

I am not a Urologist, nor an expert, just a prostate cancer patient, with a gleason score of 7, that elected to have the robotic surgery in September 2006.  I explored all options, with serveral doctors, and decided that the surgery was my best option.  The surgery was 2 hours versus 10.  That may be because I chose a surgeon that had performed over 300 robotic surgeries.  I was home within 48 hours of the surgery.  I had no problems with continence after about 6 weeks, and at 7 months I am gradually regaining potency.  My brother had the same surgery one year ago, with the same results.  Whatever option is chosen, I believe it is key to do your research and find the best surgeon/Urologist available.