Prostate Cancer treatment options advice

[alekzpolski]

POLL QUESTION CONCERNING THE BELOW: Which treatment would you advise?

My father who is 66 years of age has not so long ago been diagnozed with a higher than usual PSA of 12. Information provided by the doctor concerning the patalogical anatomy of his prostate I have over-written from portuguese and placed below. He has been presented with a number of possible treatment options.

1. External radiation + hormones. According to most it is probably to late a stage for this, but there's one hospital still considering it.
2. Brachytherapy (internal radiation, proposed by some doctors)
3. Traditional surgery of the prostate (start with a little cut in the underbelly) where the whole prostate is removed. Disadvantage of this compared to option 4 is that it's a bit more risky, the advantage is that the doctor can spot whether the tumor might have progressed further.
4. More modern surgery performed by an advanced robot (Da Vinci) which is more precise but the doctor can not see further around the region to see whether the cancer has spread.
5. HIFU (high intensity focused ultrasound) which burns away parts of the prostate but not the whole prostate. There's conflicting reports as to it's advantages/disadvantages.

All in all there's thus 5 options here that my father, currently living in Portugal, can choose from. I would be very interested in knowing your opinions on what you think would be the best treatment option based on the prostate analysis details I have provided below. Do you also recommend a certain hospital or doctor for a better outcome? I would think some of the best doctors in this field are to be found in the united states, New York for example. Right now he is schedualed to have the traditional prostate surgery (option 3) as that is what 3 doctors have advised him. Finally, are there maybe other treatment options that I do not know of?

Microscopic description:
A. right lateral base of the prostate:
2 cylyndrical fragments of prostate tissue that are in between 11 & 12 mm in length and 1mm in thickness. [Staining method: Hematoxylin and eosin stain].
B. 1/3 half way on right of prostate:
2 cylyndrical fragments of prostate tissue that are in between 10 & 15 mm in length and 1mm in thickness. [Staining method: Hematoxylin and eosin stain].
C. Right tip/Apex of prostate:
3 cylyndrical fragments of prostate tissue that are in between 2 & 12 mm in length and 1mm in thickness. [Staining method: Hematoxylin and eosin stain].
D. Left lateral base of the prostate:
4 cylyndrical fragments of prostate tissue that are in between 1 & 8 mm in length and 1mm in thickness. [Staining method: Hematoxylin and eosin stain].
E. 1/3 half way on left of prostate:
2 cylyndrical fragments of prostate tissue that are in between 12 & 15 mm in length and 1mm in thickness. [Staining method: Hematoxylin and eosin stain].
F. Left tip/Apex of prostate:
3 cylyndrical fragments of prostate tissue that are in between 3 & 10 mm in length and 1mm in thickness. [Staining method: Hematoxylin and eosin stain].
Diagnostics:

A. right lateral base of the prostate:
Adenocarcinoma of the prostate type "acinar" moderately differenciated.
Gleason score: 4+3 (60% of gleason 4).
Involved tissue: 30%.
Perineural invasions present.
Vascualr invasions absent.
Extraglandular extension missing in the analyzed samples
Number of cylinders with neoplasmic tissue: 2

B. 1/3 half way on right of prostate:
Adenocarcinoma of the prostate type "acinar" moderately differenciated.
Gleason score: 3+3
Involved tissue: 5%.
Perineural invasions absent.
Vascualr invasions absent.
Extraglandular extension missing in the analyzed samples
Number of cylinders with neoplasmic tissue: 1

C. Right tip/Apex of prostate:
Adenocarcinoma of the prostate type "acinar" moderately differenciated.
Gleason score: 4+4
Involved tissue: 5%.
Perineural invasions absent.
Vascualr invasions absent.
Extraglandular extension missing in the analyzed samples
Number of cylinders with neoplasmic tissue: 1

D. Left lateral base of the prostate:
No histologic signs of malignancy were observed in the sampled data.

E. 1/3 half way on left of prostate:
No histologic signs of malignancy were observed in the sampled data.

F. Left tip/Apex of prostate:
No histologic signs of malignancy were observed in the sampled data.

Read more: Prostate Cancer Forum - Prostate Cancer Treatment Advice http://ehealthforum.com/health/prostate-cancer-treatment-advice-t379856.html#ixzz2GpGu7YiC
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[craig1958]

I voted for the da Vinci surgery.  The magnification factor is 10x compared to the 2x used with open or laporascopic surgery.  If the tumor is outside the prostate, you can see that (they did with mine) and take additional tissue for analysis.  The advantage of that is the nerve sparing (hence, sexual function) is a much better result.

good luck

[Life360_Dave]

no i had the machine radiation not the seeds,

[alekzpolski]

You mean you had the Brachytherapy?
Thank you for your input! Any other people with comments/ideas?

[Life360_Dave]

Hi Ale, you need to find out why his psa is high and his gleason score is low. Low gleason scores show that the cancer is very slow in developing and could dye of something else before the cancer. To have is prostate removed will impair his sex life. Best to talk to the oncologist about this
My gleason was also 4 but my psa was only 5 so i opted for the radiation robotic. Its been 5 years now and my psa has been below 1.