Your Doc was correct by saying the majority of prostate cancers are slow growing but I would never consider the "wait and see" approach. The rate of growth is determined by the two diagnostic tests I mentioned previously; the PSA and the Gleason Score. The Gleason Score is done by a pathologist by looking at the cancer cells under a microscope and he will then assign a number to each positive specimen tested. If your score is between 2 & 4 you can conclude you have a less aggressive or slower growing cancer but if your score is 6 its a little faster growing and time to do something about it. If its 7 its a fast growing cancer and 8 is very fast or aggressive. But pathologists aren't perfect either and two different pathologists might give you two different readings. Also, a slow growing cancer can become a fast growing cancer, especially if you have a high testosterone level. Cancer loves testosterone like a fat lady loves chocolate eclair. Just munches it right up.Originally Posted by Kale
The best cure rates in the world for Radical Prostatectomy are at Johns Hopkins with the surgery being performed by Dr. Walsh, the man who invented the nerve sparing process and his overall cure rate is 80 percent. If some other surgeon does the surgery the cure rate will not be as high and many surgeons don't even keep tract of their patients and/or records on all of them to know their personal cure rate. If a doctor can't tell you what his cure rate is, "Walk Away" and find one who can tell you.
Radical Prostatectomy is a very serious and extremely invasive operation. It only takes one little slip of the knife and you can have serious post operative side effects to put it mildly, and quite possibly a limp weenie for the rest of your life. The total resection route is only as good as the doctor doing it!
I had absolutely no side effects from the radiation. At RCOG I had the same procedure done that Rudy Giuliani had done in New York at Mount Sinai Medical Center but at RCOG they call their procedure, "ProstRcision". The cure rate at RCOG is the best in the world. Note I didn't say just in the U.S. Below are their 10 year cure rates for ALL of over 10,000 patients:
Pretreatement PSa Groups Cure Rates
4.0 or less = 98 %
4.1 -10.0 = 90 %
10.1 - 20.0 = 75 %
More than 20.0 = 54 %
Overall = 87 %
The higher the PSA at time of treatment, the more likely the cancer has spread outside of the prostate capsule, thus the reason the percentages goes down once it's spread. The same thing holds true for Radical Prostatectomy, if one microscopic cancer cell has escaped the prostate capsule, "removing the prostate wil not cure you."
The cure rates for RCOG have been published in the Journal of Urology numerous times and using a PSA nadir cutpoint of 0.2 they have the best rates in the world. Johns Hopkins uses the Astro definition of cure with the cutpoint of 0.5 but if they used the 0.2 cutpoint their cure rates would be only 68 % for the past 15 years. The cure rate for Cryosurgery using the Astro definition of 0.5 is 73 % but would only be around 50 % if using the 0.2.
If a man has his prostate removed his PSA ought to be zero. The only thing that produces PSA is the prostate and prostate cancer cells. The reason they use the nadir of 0.2 is the machines that read the PSA are not accurate under 0.2 so they consider this as good as zero. I've had readings as low as < 0.008 but my last reading was 0.03. If it ever goes above 0.2 I'm in trouble. Hopefully none of you will ever have to worry about any of this but statistics show that 1 in 5 men will get PCa. Doc Critz at RCOG claims the older you get the more likely you'll get PCa, or in other words, if you are 70 y/o your chances are 70 % of getting it and at 80 y/o, 80 % chance, etc. I think he's right about this too. Keep a close watch on that PSA if you're taking HRT/TRT. I took it for 13 years and one day my PSA jumped thru the roof, 12.7.
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