Re: I just turned 52...

[Guest guest]

I discovered this awhile back, and it seems that these apartments are free for

those having to stay in Houston for medical treatment in the medical center

(which includes several hospitals including MD ). I don't know anyone

who has looked into this or stayed there. But, if you decide on Houston, you

might want to at least check it out. Hope this helps.

http://swamplot.com/houstons-volunteer-apartments/2010-02-12/#more-15913

>

> I live in Montana. Who's the nearest and best I need to see?

>

> (I have researched Burzynski and MD . I have insurance but am far

from able to stay in Houston for weeks)

>

> Rich Rose, aka smiley_n_mt

>

[Guest guest]

smiley_n_mt wrote:

> PCa dx 2/2009. Biopsy 2/2009=less than 5% abnormal cells both

> sides. PSA=8, latest draw 8.6 last month. Gleason=3+3, T1c.

> Maternal grandfather died of PCa at age 66. Maternal

> grandmother survived breast Ca, died at age 88 of CHF. Two

> younger sisters dx w/ BCa. Both survive after masectomy. No

> paternal data.

>

> Uroligist steers me toward surgery. (that's the wares he sells)

> Medical oncologist (1 year later) concurs. Says definitive

> results are what I am looking for as a 52 yr. old. MedOnc says

> surgery is the " gold standard " and has the definitive

> survivabilty data. Says other modalities are compared to

> surgery at least in the long-term survivability conversation.

> Suggests that 10 years life expectancy without intervention is

> not acceptable as 52 yr. old. Mrs. agrees. Urologist says

> that any of the radiation therapies alter the " tissue planes "

> making subsequent surgery " even more radical " than

> prostatectomy would be straight up out of the chute.

>

> Are my options really this limited? It seems two for two on

> the prostatectomy option.

>

> I live in Montana.

> Who's the nearest and best I need to see?

>

> (I have researched Burzynski and MD . I have insurance

> but am far from able to stay in Houston for weeks)

>

> Rich Rose, aka smiley_n_mt

Rich,

I'll take the easiest part of your query first, then give you

some ideas about the others. My personal opinion of the two

places for treatment that you mentioned is:

MD : A world famous research hospital, designated by

the National Cancer Institute as a " Comprehensive Cancer

Center " , it's highest rating for places to get treatment.

Burzynski: A world famous quack and con man, sometimes in

trouble with the law, who treats people with his own

special concoction made from cow urine, which has never

been found to be useful by anyone else who studied it,

and who won't even tell anyone exactly what's in it.

Now for the harder parts.

In reading your story, here are the questions that come to mind:

1. Do you need treatment?

2. If so, what treatment should you get?

3. Who should you get it from?

I don't think there are definitive answers to any of the

questions. The best we can do is try to determine the odds on

each side of each question and then go with the best way to

maximize those odds in favor of long term survival with minimal

side effects.

I'll take each in turn.

1. Do you need treatment?

With a Gleason 6 cancer, PSA below 10, and less than 5%

abnormal cells, the latest thinking, as best I understand it,

is that you don't yet need treatment. The cancer is likely

to stay inside your prostate for a long time, possibly many

years, before it ever threatens to break out.

However, on the other side, you have a lot of serious

hormonal related cancers (prostate and breast) in your

family, and you are only 52 years old - which means that your

chances of developing a serious cancer are possibly higher

than other men with the same stats, and you are young enough

that the cancer could very well become serious and kill you

before you're ready to die of old age.

My best guess is that you don't need treatment immediately

but you will eventually need treatment, possibly in just a

few years. If so, it may be better to get the treatment

earlier rather than later because the longer you wait, the

greater the chance of the cancer escaping the prostate and

becoming deadly.

Therefore, my inexpert layman's opinion is that you might

plan on getting treatment, but take your time to find the

best treatment for you, from the best doctor you can find.

If it takes you six months to plan the treatment, that should

be okay. Get more PSA tests during that time too to see if

the problem is getting worse more quickly than you might

expect.

A second opinion on the biopsy slides is also desirable, just

to be absolutely sure that you really do indeed have cancer,

and that it really is a Gleason 6. A second opinion is easy

to get and will probably be covered by your insurance. If

you go to a center like MD , they'll probably want to

see the slides and give you their opinion on it. If not,

there are independent labs that are judged expert in this

area.

2. If so, what treatment should you get?

The advice given to you by your urologist is probably the

conventional wisdom that more than half of the specialists

would agree with. Except for cases where it is believed that

cancer has already spread outside the prostate (in which case

external beam radiation may reach it if it hasn't gone more

than a centimeter away), I don't think any treatment exceeds

surgery in long term cancer control. Many people do indeed

consider it the " gold standard " .

One doctor I spoke to recommended surgery for all men under

60, radiation for all men over 70, and one or the other for

men in between based on their general health. Surgery is a

tougher treatment to take. Older men might not recover from

it as easily as from radiation. In addition, radiation has a

small but non-zero chance of inducing secondary cancers

decades in the future. For a 70 year old man, he probably

won't live long enough for such a secondary cancer to occur

but, in theory, a 52 year old man might.

Also, as your doctor said, surgery after radiation is not an

option. The NCI ran a clinical trial on it and halted the

trial because the damage done by surgery after radiation was

too great and outweighed its benefits. Their are surgeons

that will attempt it, but it's not recommended. However

radiation after surgery is an option and is commonly done.

Now, having said all that, I'll also tell you that I opted

for radiation at age 57. That was six years ago and I still

appear to be cancer free. I chose radiation because I

thought the side effects would be less, the success rate just

as good, and I didn't trust the surgeon that my HMO referred

me to.

The easiest treatment to take is probably brachytherapy, the

implantation of radioactive seeds. It can be done with a one

night hospital stay and you can be back at work a few days

later. If (and only if) it is done well, the side effects

are relatively bearable, the cancer control rate is probably

comparable to surgery for Gleason 6 cancers, and you don't go

out of commission with catheters and huge scars, and all the

rest for weeks of rehabilitation.

I therefore recommend: Consider surgery to be a good option,

but also speak to a good radiation oncologist. Listen to

them both.

3. Who should you get it from?

This is a key decision. The first treatment given to cure

cancer is critical. You can't easily go back and do it again

because each treatment changes your body in serious ways.

You get exactly one shot at primary treatment, and it has to

be the best shot you can take - i.e., it has to be done by

the best doctor and clinic you can find.

I seem to recall that studies suggest that the best major

operations are done by specialists who have done at least 200

of them, including about 50 per year. These are the real

specialists who have seen everything and are highly

practiced. There are surgeons performing 200 prostatectomies

a year, who have done over 2,000 of them. It's what they do

for a living. There are others who do four or five a year

and, although they may do a good job, the odds favor the real

specialists, both for cancer control and for side effects.

Ask your urologist how many he has done and how many he does

a year. I'm guessing this is not really his specialty.

Expertise and experience are also critical for radiation

oncology. A botched radiation can leave you crippled and in

pain for years with no way to fix the problem. It's

important to get it done right from someone who does lots of

prostate radiation using modern equipment.

Here is a list of NCI designated cancer centers. These are

the places that NCI thinks do an excellent job:

http://cancercenters.cancer.gov/cancer_centers

Unfortunately, none are in Montana.

These are absolutely not the only places giving great care.

There are others too. Ask around.

I hope all of that helps.

Best of luck.

Alan

[Guest guest]

There are several other options and you

are doing a good job of educating yourself by asking here. The doctors

are correct about the order of surgery. Surgery before radiation (if needed)

is a lot better than having radiation and then trying to do surgery. By

all means explore your options but as dismal as surgery sounds it is actually

not that bad. Just make sure you have a good surgeon that you are

comfortable with and has plenty of experience.

From:

ProstateCancerSupport [mailto:ProstateCancerSupport ]

On Behalf Of smiley_n_mt

Sent: Monday, May 03, 2010 6:22 PM

To:

ProstateCancerSupport

Subject: I

just turned 52...

PCa dx 2/2009. Biopsy 2/2009=less than 5% abnormal

cells both sides. PSA=8, latest draw 8.6 last month. Gleason=3+3, T1c. Maternal

grandfather died of PCa at age 66. Maternal grandmother survived breast Ca,

died at age 88 of CHF. Two younger sisters dx w/ BCa. Both survive after

masectomy. No paternal data.

Uroligist steers me toward surgery. (that's the wares he sells) Medical

oncologist (1 year later) concurs. Says definitive results are what I am

looking for as a 52 yr. old. MedOnc says surgery is the " gold

standard " and has the definitive survivabilty data. Says other modalities

are compared to surgery at least in the long-term survivability conversation.

Suggests that 10 years life expectancy without intervention is not acceptable

as 52 yr. old. Mrs. agrees. Urologist says that any of the radiation therapies

alter the " tissue planes " making subsequent surgery " even more

radical " than prostatectomy would be straight up out of the chute.

Are my options really this limited? It seems two for two on the prostatectomy

option.

I live in Montana.

Who's the nearest and best I need to see?

(I have researched Burzynski and MD . I have insurance but am far from

able to stay in Houston

for weeks)

Rich Rose, aka smiley_n_mt

[Guest guest]

Nice reply from Alan...I would add my 2 cents...Please look at Proton Beam

Therapy...

>

> PCa dx 2/2009. Biopsy 2/2009=less than 5% abnormal cells both sides. PSA=8,

latest draw 8.6 last month. Gleason=3+3, T1c. Maternal grandfather died of PCa

at age 66. Maternal grandmother survived breast Ca, died at age 88 of CHF. Two

younger sisters dx w/ BCa. Both survive after masectomy. No paternal data.

>

> Uroligist steers me toward surgery. (that's the wares he sells) Medical

oncologist (1 year later) concurs. Says definitive results are what I am

looking for as a 52 yr. old. MedOnc says surgery is the " gold standard " and has

the definitive survivabilty data. Says other modalities are compared to surgery

at least in the long-term survivability conversation. Suggests that 10 years

life expectancy without intervention is not acceptable as 52 yr. old. Mrs.

agrees. Urologist says that any of the radiation therapies alter the " tissue

planes " making subsequent surgery " even more radical " than prostatectomy would

be straight up out of the chute.

>

> Are my options really this limited? It seems two for two on the prostatectomy

option.

>

> I live in Montana. Who's the nearest and best I need to see?

>

> (I have researched Burzynski and MD . I have insurance but am far

from able to stay in Houston for weeks)

>

> Rich Rose, aka smiley_n_mt

>

[Guest guest]

>

>

> PCa dx 2/2009. Biopsy 2/2009=less than 5% abnormal cells both sides.

> PSA=8, latest draw 8.6 last month. Gleason=3+3, T1c. Maternal

> grandfather died of PCa at age 66. Maternal grandmother survived breast

> Ca, died at age 88 of CHF. Two younger sisters dx w/ BCa. Both survive

> after masectomy. No paternal data.

That looks to me like enhanced risk.

(snip)

> I live in Montana. Who's the nearest and best I need to see?

>

> (I have researched Burzynski and MD . I have insurance but am

> far from able to stay in Houston for weeks)

I note that a warning about Burzynski the Quack has been duly

given. I agree.

So far as whom to see, I recommend contacting the Help Line at

the Prostate Cancer Research Institute. See:

http://www.prostate-cancer.org/pcricms/node/89

Regards,

Steve J

[Guest guest]

Rich --

I agree, almost word-for-word, with what Alan wrote. With a PSA of 8, assuming

that you don't have a prostate infection or BPH, you will probably need

treatment eventually. And " sooner " gives you a better chance of dying

cancer-free, than " later " .

The " almost . . . " part:

The long-term results of brachytherapy -- done by high-volume

radiation-treatment centers -- may be as good as surgical results. This seems

to be true for a local group in Vancouver BC, but I don't think their results

have been published yet.

Talk with a good radiation oncologist about that option. [Gee, that's what Alan

said . . . <g>]

Surgeons and radiation oncologists tend to understate the prevalence and

severity of side-effects. The best book I've seen on sexual side-effects is:

" Saving Your Sex Life: A Guide to Men with Prostate Cancer " , by P.

Mulhall.

It's worth reading. You're young, and your cancer is early-stage. With luck,

you'll be on the " good side " of the side-effects bell curve.

The shock of a cancer diagnosis takes a while to wear off. Let us know if you

have more questions.

> >

> > I live in Montana. Who's the nearest and best I need to see?

> >

> > (I have researched Burzynski and MD . I have insurance but am far

from able to stay in Houston for weeks)

> >

> > Rich Rose, aka smiley_n_mt

> >

>

[Guest guest]

Many thanks to all who responded.

It is reassuring to find a group of folks who are knowledgeable and concerned

for each other's well-being.

We are currently reading and studying as much material as possible and weighing

our options. It is true I am considered " low risk " and more than likely have

the luxury of time on my side but the genetic component of family history is a

bit disconcerting.

With highest regard for each of you,

Rich and Sue

p.s. today's thought for us is to consult a radiation oncologist and adjust

dietary and lifestyle considerations. (I am not vegetarian. Sugar, especially

white refined sugar, intake is not a vice of mine. I do sneek a smoke once in

awhile. I average 1 beer a day. Some days none, others two or three.)

I am concerned that radiation, once implemented, may alter the tissue planes and

make a subsequent surgery more difficult if not impossible, making surgery a

first and best option.

I am concerned that as a " low risk " patient, that I might be consumed by the

psychological negativity of a PCa dx and submit myself to the multi-billion

dollar western medical machine and find myself overtreated unnecessarily.

I am thankful for this group.

[Guest guest]

Rich:

You make an interesting point in the last line of your note. I was a "low risk" cancer patient, 3+3, T1, one sample out of 12 malignant, nothing found in several DREs. But I went ahead with radiation treatment anyway. Bottom line, PSA of less than .1. But I'll never know how urgent the need for treatment was. Perhaps I could have done watchful waiting, but no need for what if's. The only concern I have is that, I believe I'm correct, I cannot have radiation treatment again for any prostate cancer reoccurrence or any other cancer.

The very best to you both as you take on this monster.

Tom

Re: I just turned 52...

Many thanks to all who responded.It is reassuring to find a group of folks who are knowledgeable and concerned for each other's well-being.We are currently reading and studying as much material as possible and weighing our options. It is true I am considered "low risk" and more than likely have the luxury of time on my side but the genetic component of family history is a bit disconcerting.With highest regard for each of you,Rich and Suep.s. today's thought for us is to consult a radiation oncologist and adjust dietary and lifestyle considerations. (I am not vegetarian. Sugar, especially white refined sugar, intake is not a vice of mine. I do sneek a smoke once in awhile. I average 1 beer a day. Some days none, others two or three.) I am concerned that radiation, once implemented, may alter the tissue planes and make a subsequent surgery more difficult if not impossible, making surgery a first and best option.I am concerned that as a "low risk" patient, that I might be consumed by the psychological negativity of a PCa dx and submit myself to the multi-billion dollar western medical machine and find myself overtreated unnecessarily.I am thankful for this group.

[Guest guest]

THANK you so much for your note. It sure helps..and makes for feeling assured you made the right decison. At least I'm feeling that way. GOOD LUCK...

To: ProstateCancerSupport Sent: Wed, May 5, 2010 9:40:17 AMSubject: Re: Re: I just turned 52...

Rich:

You make an interesting point in the last line of your note. I was a "low risk" cancer patient, 3+3, T1, one sample out of 12 malignant, nothing found in several DREs. But I went ahead with radiation treatment anyway. Bottom line, PSA of less than .1. But I'll never know how urgent the need for treatment was. Perhaps I could have done watchful waiting, but no need for what if's. The only concern I have is that, I believe I'm correct, I cannot have radiation treatment again for any prostate cancer reoccurrence or any other cancer.

The very best to you both as you take on this monster.

Tom

[ProstateCancerSupp ort] Re: I just turned 52...

Many thanks to all who responded.It is reassuring to find a group of folks who are knowledgeable and concerned for each other's well-being.We are currently reading and studying as much material as possible and weighing our options. It is true I am considered "low risk" and more than likely have the luxury of time on my side but the genetic component of family history is a bit disconcerting.With highest regard for each of you,Rich and Suep.s. today's thought for us is to consult a radiation oncologist and adjust dietary and lifestyle considerations. (I am not vegetarian. Sugar, especially white refined sugar, intake is not a vice of mine. I do sneek a smoke once in awhile. I average 1 beer a day. Some days none, others two or three.) I am concerned that radiation, once implemented, may alter the tissue planes and make a subsequent surgery more difficult if not impossible, making surgery a first and best

option.I am concerned that as a "low risk" patient, that I might be consumed by the psychological negativity of a PCa dx and submit myself to the multi-billion dollar western medical machine and find myself overtreated unnecessarily.I am thankful for this group.

[Guest guest]

Hi, smiley_n_mt

I am 72 years old and about to finish my 39 treatments of external beam radiation. I was diagnosed with prostate cancer in January 2010, biopsy showed 2-Gleason 6+3 and 2-Gleason 7 3+4 which put me in the intermediate group. In 1996 I had a 5 heart bypass procedure. The reason i mention this is that in both cases i gave my problem to the Lord. In each case He made it easy for me. So don't be consumed by any psychological negativity of your dx. Pray to Him, do your research,and let him lead you to the proper procedure.

May He bless you and heal you.

.

Re: I just turned 52...

Many thanks to all who responded.It is reassuring to find a group of folks who are knowledgeable and concerned for each other's well-being.We are currently reading and studying as much material as possible and weighing our options. It is true I am considered "low risk" and more than likely have the luxury of time on my side but the genetic component of family history is a bit disconcerting.With highest regard for each of you,Rich and Suep.s. today's thought for us is to consult a radiation oncologist and adjust dietary and lifestyle considerations. (I am not vegetarian. Sugar, especially white refined sugar, intake is not a vice of mine. I do sneek a smoke once in awhile. I average 1 beer a day. Some days none, others two or three.) I am concerned that radiation, once implemented, may alter the tissue planes and make a subsequent surgery more difficult if not impossible, making surgery a first and best option.I am concerned that as a "low risk" patient, that I might be consumed by the psychological negativity of a PCa dx and submit myself to the multi-billion dollar western medical machine and find myself overtreated unnecessarily.I am thankful for this group.

[Guest guest]

THANK YOU GEORGE..i startd my first radiation treatment yesterday.. Was diagnosed in Oct...09...psa was 15....my gleason score was 7. I had to have three more stents put in three weeks ago..so the HIGH DENSITY was exchanged for the hormone/external radiation. So far...the FLASHES are not good...and have not had enough radiation to know what I'm going to deal with. SAME WITH YOU ...I now have 7 stents...doing fine ...and will get thur this as well. I'm also 73 next month...work part time..go to the Y faithfully three times a week and try to fit tennis in twice. GOT TO HELP THE LORD KEEP THE OLD BOD MOVING!

JIM in Waukesha Wisconsin

To: ProstateCancerSupport Sent: Wed, May 5, 2010 5:46:25 PMSubject: Re: Re: I just turned 52...

Hi, smiley_n_mt

I am 72 years old and about to finish my 39 treatments of external beam radiation. I was diagnosed with prostate cancer in January 2010, biopsy showed 2-Gleason 6+3 and 2-Gleason 7 3+4 which put me in the intermediate group. In 1996 I had a 5 heart bypass procedure. The reason i mention this is that in both cases i gave my problem to the Lord. In each case He made it easy for me. So don't be consumed by any psychological negativity of your dx. Pray to Him, do your research,and let him lead you to the proper procedure.

May He bless you and heal you.

.

[ProstateCancerSupp ort] Re: I just turned 52...

Many thanks to all who responded.It is reassuring to find a group of folks who are knowledgeable and concerned for each other's well-being.We are currently reading and studying as much material as possible and weighing our options. It is true I am considered "low risk" and more than likely have the luxury of time on my side but the genetic component of family history is a bit disconcerting.With highest regard for each of you,Rich and Suep.s. today's thought for us is to consult a radiation oncologist and adjust dietary and lifestyle considerations. (I am not vegetarian. Sugar, especially white refined sugar, intake is not a vice of mine. I do sneek a smoke once in awhile. I average 1 beer a day. Some days none, others two or three.) I am concerned that radiation, once implemented, may alter the tissue planes and make a subsequent surgery more difficult if not impossible, making surgery a first and best

option.I am concerned that as a "low risk" patient, that I might be consumed by the psychological negativity of a PCa dx and submit myself to the multi-billion dollar western medical machine and find myself overtreated unnecessarily.I am thankful for this group.

[Guest guest]

Hi,

Alan always give such great info and well researched too.

I would like to add some. I have had prostrate surgery and radiation. Think about two curative options and surgery unless done first cannot be done after radiation. So if you have surgery first then you have a curative option of radiation after. I should have taken a friends advice and found the very best surgeon I could. My surgery was production line and was done wirh old and cheap equipment and methodology. I should have done like Alan said and gone to a very experienced surgeon and the very best no matter where they are.Like your time and reseach it like Alan says. Less problems and better results.

Your Gleason score puts you on the boarderline of it reoocurring but I would give myself two currative options with surgery with the very best doctor and equipment wherever that is at whatever cost then radiation incase it comes back. I had radiation and am not sure which is better related to brach.......

Best Wishes,

Tom W.

To: ProstateCancerSupport Sent: Mon, May 3, 2010 7:17:05 PMSubject: Re: I just turned 52...

smiley_n_mt <smiley_n_mt@ yahoo.com> wrote:> PCa dx 2/2009. Biopsy 2/2009=less than 5% abnormal cells both> sides. PSA=8, latest draw 8.6 last month. Gleason=3+3, T1c.> Maternal grandfather died of PCa at age 66. Maternal> grandmother survived breast Ca, died at age 88 of CHF. Two> younger sisters dx w/ BCa. Both survive after masectomy. No> paternal data.> > Uroligist steers me toward surgery. (that's the wares he sells)> Medical oncologist (1 year later) concurs. Says definitive> results are what I am looking for as a 52 yr. old. MedOnc says> surgery is the "gold standard" and has the definitive> survivabilty data. Says other modalities are compared to> surgery at least in the long-term survivability conversation.> Suggests that 10

years life expectancy without intervention is> not acceptable as 52 yr. old. Mrs. agrees. Urologist says> that any of the radiation therapies alter the "tissue planes"> making subsequent surgery "even more radical" than> prostatectomy would be straight up out of the chute.> > Are my options really this limited? It seems two for two on> the prostatectomy option. > > I live in Montana. > Who's the nearest and best I need to see?> > (I have researched Burzynski and MD . I have insurance> but am far from able to stay in Houston for weeks)> > Rich Rose, aka smiley_n_mtRich,I'll take the easiest part of your query first, then give yousome ideas about the others. My personal opinion of the twoplaces for treatment that you mentioned is:MD : A world famous research hospital, designated bythe National Cancer

Institute as a "Comprehensive CancerCenter", it's highest rating for places to get treatment.Burzynski: A world famous quack and con man, sometimes introuble with the law, who treats people with his ownspecial concoction made from cow urine, which has neverbeen found to be useful by anyone else who studied it,and who won't even tell anyone exactly what's in it.Now for the harder parts.In reading your story, here are the questions that come to mind:1. Do you need treatment?2. If so, what treatment should you get?3. Who should you get it from?I don't think there are definitive answers to any of thequestions. The best we can do is try to determine the odds oneach side of each question and then go with the best way tomaximize those odds in favor of long term survival with minimalside effects.I'll take each in turn.1. Do you need treatment?With

a Gleason 6 cancer, PSA below 10, and less than 5%abnormal cells, the latest thinking, as best I understand it,is that you don't yet need treatment. The cancer is likelyto stay inside your prostate for a long time, possibly manyyears, before it ever threatens to break out.However, on the other side, you have a lot of serious hormonal related cancers (prostate and breast) in yourfamily, and you are only 52 years old - which means that yourchances of developing a serious cancer are possibly higherthan other men with the same stats, and you are young enoughthat the cancer could very well become serious and kill youbefore you're ready to die of old age.My best guess is that you don't need treatment immediatelybut you will eventually need treatment, possibly in just afew years. If so, it may be better to get the treatmentearlier rather than later because the longer you wait, thegreater

the chance of the cancer escaping the prostate andbecoming deadly.Therefore, my inexpert layman's opinion is that you mightplan on getting treatment, but take your time to find thebest treatment for you, from the best doctor you can find.If it takes you six months to plan the treatment, that shouldbe okay. Get more PSA tests during that time too to see ifthe problem is getting worse more quickly than you mightexpect.A second opinion on the biopsy slides is also desirable, justto be absolutely sure that you really do indeed have cancer,and that it really is a Gleason 6. A second opinion is easyto get and will probably be covered by your insurance. Ifyou go to a center like MD , they'll probably want tosee the slides and give you their opinion on it. If not,there are independent labs that are judged expert in thisarea.2. If so, what treatment should you

get?The advice given to you by your urologist is probably theconventional wisdom that more than half of the specialistswould agree with. Except for cases where it is believed thatcancer has already spread outside the prostate (in which caseexternal beam radiation may reach it if it hasn't gone morethan a centimeter away), I don't think any treatment exceedssurgery in long term cancer control. Many people do indeedconsider it the "gold standard".One doctor I spoke to recommended surgery for all men under60, radiation for all men over 70, and one or the other formen in between based on their general health. Surgery is atougher treatment to take. Older men might not recover fromit as easily as from radiation. In addition, radiation has asmall but non-zero chance of inducing secondary cancersdecades in the future. For a 70 year old man, he probablywon't live long enough for such a

secondary cancer to occurbut, in theory, a 52 year old man might.Also, as your doctor said, surgery after radiation is not anoption. The NCI ran a clinical trial on it and halted thetrial because the damage done by surgery after radiation wastoo great and outweighed its benefits. Their are surgeonsthat will attempt it, but it's not recommended. Howeverradiation after surgery is an option and is commonly done.Now, having said all that, I'll also tell you that I optedfor radiation at age 57. That was six years ago and I stillappear to be cancer free. I chose radiation because Ithought the side effects would be less, the success rate justas good, and I didn't trust the surgeon that my HMO referredme to.The easiest treatment to take is probably brachytherapy, theimplantation of radioactive seeds. It can be done with a onenight hospital stay and you can be back at work a few

dayslater. If (and only if) it is done well, the side effectsare relatively bearable, the cancer control rate is probablycomparable to surgery for Gleason 6 cancers, and you don't goout of commission with catheters and huge scars, and all therest for weeks of rehabilitation.I therefore recommend: Consider surgery to be a good option,but also speak to a good radiation oncologist. Listen tothem both.3. Who should you get it from?This is a key decision. The first treatment given to curecancer is critical. You can't easily go back and do it againbecause each treatment changes your body in serious ways.You get exactly one shot at primary treatment, and it has tobe the best shot you can take - i.e., it has to be done bythe best doctor and clinic you can find.I seem to recall that studies suggest that the best majoroperations are done by specialists who have done at least

200of them, including about 50 per year. These are the realspecialists who have seen everything and are highlypracticed. There are surgeons performing 200 prostatectomiesa year, who have done over 2,000 of them. It's what they dofor a living. There are others who do four or five a yearand, although they may do a good job, the odds favor the realspecialists, both for cancer control and for side effects.Ask your urologist how many he has done and how many he doesa year. I'm guessing this is not really his specialty.Expertise and experience are also critical for radiationoncology. A botched radiation can leave you crippled and inpain for years with no way to fix the problem. It'simportant to get it done right from someone who does lots ofprostate radiation using modern equipment.Here is a list of NCI designated cancer centers. These arethe places that NCI thinks do an excellent

job:http://cancercenter s.cancer. gov/cancer_ centersUnfortunately, none are in Montana.These are absolutely not the only places giving great care.There are others too. Ask around.I hope all of that helps.Best of luck.Alan