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1st stage prostate cancer: to operate or not?

56 years diagnosed with 1st stage prostate cancer.

Consulted 3 doctors.
1. One said to operate.
2. Second said not to operate and keep observing.
3. Third said you can operate OR keep observing.

So 50/50 split.

What would you do?

How to reach the right conclusion?

Are there ways to prevent further development of cancer?

Hard to evaluate risk/reward in this case and looking for help.

  1. How to reach the "right conclusion" is not a simple go/no decision. It appears from your description that your Gleason Score (aggressiveness score) may be low or borderline since no one told you to treat it ASAP. The MD who said you can treat or keep observing may have said it best. It is up to you to decide. Are you comfortable waiting and knowing cancer is growing in your prostate or do you just want to get it treated now? Only you know how you feel. You mentioned surgery or observation. Did anyone mention other treatment options such as hormone therapy, freezing, radiation or proton etc?
    There are consequences with all options - treatment or waiting. And if you are waiting ask yourself what is the trigger that will motivate you to move forward or continue waiting. It all boils down to your comfort level and an understanding of the impact your actions will have on your life and sex life. Prostate cancer is slow growing = you have time to think things over - so best not to jump to a decision. Whatever you decide will be the best decision for you. M y only suggestion is ... once you make a decision do not look back ... just know it was the best for you at the time. ... Dennis( Team)

    1. Hi . First. let me mention that Cyberknife isn't new. It has been used for brain cancer, lung cancer, and others previous to prostate cancer. This article is an example of a pretty large study finding stereotactic body radiotherapy (which is what Cyberknife is)) effective for low and intermediate risk prostate cancer: In addition, this article discusses a study published in the Lancet Oncology journal finding that those treated with Cyberknife had lower levels of acute genitourinary toxicity than those treated with standard radiation:
      I can tell you more anecdotally that my father-in-law was successfully treated at Columbia University, where they have done more Cyberknife treatments than anywhere else in the U.S. He was treated with a combination of Cyberknife and standard radiation because he had a high-grade of prostate cancer and the doctors wanted to increase the margins (Cyberknife has very specific margins and has the ability to adjust to intestinal movements and even movements from breathing).
      Of course, this is not to say that this would be the appropriate treatment in your case. Every case is unique and the proper treatment depends on multiple factors; such as grade of cancer, spread, personal health circumstances, and others. The medical team you decide on should present multiple options and lay out the case for each in relation to your circumstances. Wishing you the best. Richard ( Team)

  2. You are pretty much where I was when diagnosed. I did decide to undergo treatment rather than waiting for my (3+4)s to become (4+3)s though I was told repeatedly that I had plenty of time to decide.

    When you look for advice and treatment, get as many opinions as you feel you need. A great many doctors tend to be a bit parochial and since their main tool is a hammer all problems are nails. They focus on their little project and seem to have either no interest or awareness of what you will be living with after their project is done.

    Also make sure you are looking for the most recent information. Much of what you find on line and even from doctors is quite dated. Several medical providers I've dealt with were pretty much behind the information curve. I find videos from Dr. Mark Scholz to be very informative.

    Guy B. Meredith, moderator.

    1. I opted for 28 sessions of radiation with the Varian Truebeam and 6 months of ADT with Lupron. You can find videos of the Truebeam on Youtube. The ADT was optional. Interestingly it was my urologist who told me that I had made the single best choice for beating the cancer.

      I was 74 at the time I made my choice of treatment. Firstly, the successful outcome of surgery is dependent on too many random factors for my comfort and I just do not like the idea of being under the knife. Next, with surgery I MIGHT recover erectile function without need for aids and MIGHT recover from incontinence and those MIGHT happen before I am too old to enjoy the success. With radiation I MIGHT suffer prematurely aged erectile blood vessels in a few years and I MIGHT run into urinary problems in a few years.

      I decided that I would prefer to have the guarantee that I would be able to enjoy sex and continence for at least a few years. Dr. Scholz mentions that if men retain sexual function two years after radiation, any decrease after that point is probably from natural aging.

      After 11 months I think I am now free of all effects of ADT, have had minor proctitis treated with laser ablation and have had full sexual function both during and after treatment.

      Guy B. Meredith, moderator.

    2. Something else to consider is what your options will be should the cancer recur.

      My OR told me that radiation would not be an option after initial treatment with radiation. This led me to almost changing my mind at the last minute. I'm glad I didn't.

      There is some debate as to whether surgery can be used for salvage after radiation given that current radiation technology does less damage to the anatomy than past technology. For surgery, radiation and ADT are the common route.

      I think that should I need further treatment I will probably opt for ADT. ADT may not prove effective over a very long period of time and surgery may then be an option.

      Guy B. Meredith, moderator.

  3. ironically today marks two years since I received my diagnosis of prostate cancer. My 12-cut biopsy showed 4 tumours with Gleason scores of 4+3 and 3+4 and my risk was assessed as intermediate. My urologist gave me two options for treatment; radiotherapy and robotic surgery and gave the pros and cons of each. He strongly advised that I should consider surgery because in the event the cancer returns, radiotherapy can be used but if I first opt for radiation, surgery will not be an option plus there was the issue of LUTI! Ironically I was 57 and was told that my (young) age was in my favour and I have to decide on my treatment option within two months following the biopsy as no treatment could commence before this period elapsed. So in January 2021 I underwent surgery and I’m cancer free and back to regular programming!

    1. You took the right decision in consultation with your doctor in view of the multi focal nature of your 4+3/3+4 PCa. Wish you the best.

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