If you are a man, and fortunate to live to the age of 70, you have a 1 in 9 chance of developing prostate cancer. So far, western medical science has not concluded that there is any specific cause to this, such as diet, genetics, or just living long enough that bad things will begin to happen as we age.
Unless you have an enlarged prostate causing urinary blockage, or your urologist has some specific reason to run a prostate biopsy, there is a chance that you may have been living with this cancer and not knowing it. However, for the purpose of this article, let’s assume that you were biopsied and given the bad news that you have Stage I cancer. The Gleason Score you are told is a 6 ( or 3 + 3), which is the measure of cancer cell appearance and degree of aggressiveness, and whether the cancer is still physically confined within the prostate’s capsule. If you have to have this cancer, if its still Stage I this is good news.
In other words, while this is bad news overall to have this cancer, it fortunately is in its very early stages, unless you are already in Stage II or higher.
It is fairly typical that a urologist may advise you to take a “wait and see” position, to continue to monitor it, see whether the PSA score changes, if the Gleason score increases, or if future biopsies show that there is an increase in the size of the tumorous cells. The doctor advising this wait and see is trying to save you the trauma of having to go through surgery and have to deal with all the side effects that occur during recovery. After all this is a normally a very slow-moving cancer and with a 3+3 Gleason, may not even change for another 5 or 10 years. However, this article questions whether this waiting and observing is really in your best interest.
Your age is also a very important factor. If this cancer is detected and you are a 3+3 Gleason and you are over 80, perhaps the best decision is to do nothing because it is very likely at this stage in your life that prostate cancer will not be the cause of death. However, if you are in you early 70’s or younger, there is plenty of time for the prostate cancer to grow, become more aggressive, and metastisize and spread. You are also relatively young and more able to handle the surgery and deal with the side-effects. Just from the psychological point of view, you may not want to spend years living with a live cancer festering in your body.
Most men opt for the “wait and see” choice, delaying any sort of invasive treatment as far as they can into the future. It is always easier to delay unpleasant things into the future and not deal with them now. However, the best time to deal with this cancer is in its early state – Stage I. There is approximately a 95% chance that removing the prostate will permanently eliminate the cancer. There are no 100%’s in medicine, and there is still approx. a 5% chance that even early stage prostate cancer may have already released cells into your bloodstream, testicular vessels, or lymph nodes and already started to spread microscopically. However, the odds at this stage that this has not occurred are still very good and worth considering, in making your decision.
This surgery is usually performed by robotics, using the Da Vinci machine, where the surgeon sits at a computer console, controlling the 5 arms of the machine. Though invasive, at the hands of a skilled surgeon it is minimally invasive, recovery is relatively quick, and the chances of the side-effects becoming permanent are reduced. Waiting and allowing this cancer to change and grow may not be the best option for long-term survival.
My first reaction to having such a problem, would be that its time to go diving and forget about this for a while. However, the responsible thing to do in this case, might just be to first take care of the problem and have many more dives ahead of you in life.
Is proton therapy a good treatment for prostate cancer? My Gleason score is a 6, I have that two biopsy and both had 3 out of 12 samples positive. We are on a surveillance, keeping a watch and checking my PSA every 3 months. I am going on 3 years know.
Hi Daniel-
I also had a Gleason 3+3 with 3 out of 12 samples positive. I chose to remove it while it was still in its earliest stage (I) and hopefully not worry about it in the future. The sooner you catch it and remove it, the higher the probability that it disappears permamnently.
Proton therapy is radiation. That is also a choice, though not one for me. Did your urologist explain that once you have had radiation, you forfeit the choice of removing the prostate in the future because of the scar tissue caused by the radiation?
Removing your prostate also has the side benefit of improving flow … permanently.
Depending upon a man’s age, the younger you are the more time the cancer will have to grow if you are sitting back and observing. If you were in your 80’s, then observing it becomes a better choice since you will more likely will die from something else than from the prostate at that point in life.
It is a difficult decision to make to remove it. The operation, the recovery and side-effects, plus exercises. But eventually, you heal and lead a fairly normal life. We are not doctors so this is not medical advice. Just some thoughts from someone who made another choice than what you did and also did not follow my initial doctor’s advice. Good luck to you.
My Gleason score was 3plus 4 (7) with one out of 16 samples showing a small amt of cancer. One Urologist thought I could watch and wait while the second one felt it should be removed, I chose to remove it. Two weeks later the full biopsy came back identifying a very small tertiary cancer cell that put my Gleason score to an eight or nine. Luckily I caught this early on in its infancy and it was still confined to the prostate. The Urologist mentioned had I waited 6-8 months the cancer would have started to track outside the prostate. So far 3 years post surgery the PSA is undetectable.
Excellent! That’s the whole point we are making. If you wait, it might get too late. Then you are screwed and faced with chemo. I still don’t understand why so many doctors do that “wait and see” approach. Inevitably it is going to grow and escape the prostate capsule. Whereas my surgeon who is head of the dept. of urology at UCSD medical center said that taking it out was the right decision.