Treatment

  I'd like some suggestions about PC treatment.  Here's the story:
  55 y/o otherwise excellent health
  PSA - 4.0; free PSA - 5 percent
  Needle bx: Gleason 2+2=4; right side only; TRUS negative.
  Questions:
  1.  What additional tests/scans should be done before surgery?
  2.  Should other treatment options be considered?
  3.  Autologous blood donations?
  4.  Hormone treatment before surgery?  Prostate is 19.65 cc.
  5.  Wise to have surgery right away or possible to wait until mid-December?
  6.  Heard it was unwise to do surgery within two months of needle bx.  Is this true?
  7.  Survival rate?
  8.  Chances of regaining full sexual potency without artificial aids?  (Assuming nerve-sparing.)
  9.  Any benefit in test for p27 protein?
  10.  Importance of use of "CaverMap"?  (www.fda.gov/fdac/features/1998_pros.html)
  11.  Effect of RP on orgasm?
  12.  How long will I be disabled from normal daily activities?
  Thanks,  Bill R.

[hfhs M.D.-AK]

Dear Bill,
I will attempt to answer all of your questions directly in my response to your question, but you said it yourself, you are a healthy 55 year old with prostate cancer detected at a low stage.  Both your PSA and Free PSA are in high risk ranges, and are why your doctor wanted you to have a biopsy.  The biopsy results show a low grade of prostate cancer, one that is usually confined within the prostate gland.  There are other tests that we run on people with higher PSA or symptoms suggesting metastatic spread, but you do not fall into this category.  The amount of information at this time is sufficient for some type of intervention.  Due to your health status and the high probability of organ confined disease(no spread), I would initially recommend surgery.  Your other options include radiation therapy(external-bean or seed implantation), cryotherapy(freezing the prostate), hormonal therapy or watchful waiting(following the PSA periodically).  I think most urologist would recommend surgery or one of the other intervention procedures.  I don