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Urology/MP-MRI with 18.8 PSA and 7 Gleason

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Question
Background:
Age:59; Ht:5'8"; Wt:182; Health: Excellent; PSA History: 24 mons ago 9, 12 mons ago 10.5, 2 months ago 18.8. Needle biopsy 3 of 36 samples showed cancer. CAT scan did not show migration to lymphatic. Johns Hopkins assessed Gleason score of 7(3+4). Sexually active 4-5 times a week with same female partner (not taking Viagra).

Questions:
1. Would mp-MRI confirm my prostate cancer diagnosis then help see / localize it to guide treatment?
2. A week ago, I started having 2 cups per day of organic Green Tea. I have heard this has been effective in driving down the PSA score #friend was PSA 16, then down to under 4 within 30 days#. My plan is to keep with the tea and check the PSA in 30 days to help decide if surgery or radiation is needed. What do you think of this strategy?
3. Assuming observation with dietary changes are not practical AND either radiation or surgery are equally effective in removing/stopping the cancer, then which treatment (radiation or surgery), would provide the best chances for maintaining this level of sexual activity.
4. Which treatment would you advise? (dietary, surgery, or radiation)?

Answer
Chuck:

Your diagnosis is confirmed by the biopsy.  At this point, not much gained by doing MRI.  However, you probably need a bone scan.

Expecting organic tea to adequately treat or control your biopsy proven Gleason 7 prostate cancer is foolish and unwise.  At age 59, a more dfinitive treatment is called for.

WIth a high PSA and gleason 7 disease, you are not a good candidate for active surveillance.

Radiation therapy would have a lower incidence of sexual dysfunction than surgery.

Radiation and surgery have roughly equal long term survival and cure rates, but surgery has almost double the complications so I tend to lean towards radiation.  You should speak to a radiation therapist and a surgeon to get their opinions and data before deciding.  Diet is not a treatment.

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Stephen W. Leslie, MD

Expertise

Questions concerning erectile dysfunction, kidney stones and prostate disorders including prostate cancer. I have a special interest in kidney stone disease prevention.

Experience

Full time practicing urologist with 30 years experience. Associate Professor of Surgery and Chief of Urology at Creighton University Medical Center. Editor in Chief of eMedicine Urology internet textbook. Author of only NIH approved book written for patients by a urologist on the subject of kidney stones "The Kidney Stones Handbook". Inventor of the "Parachute" and "Escape" kidney stone baskets and the "Calculus" stone prevention analysis computer program.

Organizations
American Urological Association, Ohio State Medical Association, Sexual Medicine Society

Publications
Men's Health, Journal of Urology, Urology, Healthwatch Magazine, Emergency Medicine Monthly, eMedicine, "The Kidney Stones Handbook", and numerous articles in various newspapers. He is also the editor of the Urology Board Review by McGraw-Hill used by urologists to study for their Board Certification Examinations.

Education/Credentials
Graduate of New York Medical College with residencies completed at Metropolitan Hospital New York, Albany Medical Center and University of Wisconsin-Madison.

Awards and Honors
Thirlby Award of the American Urological Association. Rated as one the country's Best Urologists by the Independent Consumer's Research Institute

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