Hi! 68 years old, just diagnosed with prostate Cancer. Thankfully localized however 7 positive cores, Gleason 7 in 6 and Gleason 6 in only 1. Psa 9.6. Seems results are the same with either radiation or Surgery and can't understand how to make this decision as doctors are telling me all present with same odds. 2 biggest things on my mind is 1) why surgery if results are the same as radiation and 2) with radiation, I am frightened of having to look over my shoulder for 2 years, watching PSA potentially bounce up and down and not know if cancer really gone. And if unsuccessful, there's no surgery as an option after that. Please help!
(We are in the USA) My spouse was age 64 when he was diagnosed with advanced PCa, localized in prostate, Gleason 8 and 9, otherwise in excellent health, normal sized prostate gland. He had 6 months of ADT, also had seed implants and at the 5 months of ADT, he had EBRT. Few, if any side effects. We hike, ski, climb, etc and do everything we did before his treatment. BUT, he has no sex drive. NO bladder problems, His testosterone level is low. There is NO evidence of any cancer. Its been 4 years, He is fine with the results, and is happy he did NOT have surgery. At 74, Ive just been diagnosed with intermediate PCa, Gleason 6, 2 with 7, excellent health, decided to do 6 months of ADT plus seeds. National Cancer treatment guidelines do NOT suggest surgery for men with low or intermediate PCa. PS, I was on watchful waiting for 3 years.
Hi Jerald,
THe data these days tells us to wait and keep an eye on it? But please don't take my word. I'm no doctor. I had surgery 16 months ago and still have NO normal sex life.
Bladder ok. Do Wonder if I had kept an eye on it (PSA was 4.7) rather than have gone through the mental torment that is a sex life that is non existant and/or otherwise a trial. DIdn't realise it before and took a normal sex life for granted. Get as much advice as you can. It's a lottery.
Thank you for your response. I am surprised you said National Cancer guidelines say not to do surgery at low and intermediate,. I thought it was the opposite because these groups supposedly have longer life span hence if recurrence occurred other options possible. Did u choose ADT to be more aggressive with radiation? How is your recovery going?
I am sorry you are dealing with this. Where do you live?
Hi Jerald1234,
Faced with the same decision I opted for surgery for four main reasons:
1. Surgery is impossible after radiotherapy but radiotherapy is possible after surgery (and may be necessary if surgery has not removed cancerous cells with a wide enough margin).
2. Radiotherapy requires anti testosterone treatment first - the side effects are not wonderful
3. The collateral damage from radiotherapy can be enduring and not at all nice - especially to the rectum and bladder.
4. Both surgeons I discussed this with (one in UK oe in Australia) accepted that surgeons and physicians would never agree but said that there was no way they would put themselves through radiotherapy unless it was impossible to avoid it. They also felt that with robotic surgery there was a greater chance of regaining normal continance and erections after surgery than after radiotherapy.
Good luck whatever you decide. It's not as black and white as I have made it seem or the decision would be a no brainer.
Thank you. How's your recovery?
Lol, I'm waiting for the op. It's set for 24th January.
I had a score of 7 and opted for radiation I have had 5 treatments. My Urologist told me that after radiation surgery is not possible, but the radiation oncologist told me it is possible just a bit more difficult.
I'm also very curious, when were seeds placed? During ADT? And why EBRT, were his numbers rising or the doctors just wanted to be as aggressive as possible? Thanks!
Sounds like you can avoid surgery and opt for other treatment options. The seed implants work... some guys have the seed implants along with radiation depending on the degree of cancer in the prostate. There is a good website for the Prostate Treatment Research Foundation. This website shows different treatment options and their success rates. It would be a good one for you to check out. I had the seed implants - Brachytherapy nearly 8 months ago. So far, I am doing well. At my 6 month follow up, my PSA was down to 0.15. A few side effects in the first 2 to 3 months, but nothing servere. Ibuprofen helps with discomfort from the inflammation caused by the radiation. The good thing about the seed implants is that the radiation is very low. It is consentrated to the prostate which cuts down on the exposure to the bladder and rectum. After several months, the radiation is gone... it has done its job. Good luck to you... keep us posted on your decision.
I am in conversation with a very good Interventional Radiologist who is treating lower and intermediate PCa in Prostate with a 3TMRI and doing focal laser targeted biopsy and he is also treating the lesions with focal laser ablation for cancer removal. The benfits are termendous with little to know side effects especially no sexual side effects as all of the ablation is mapped out and is done with the real time 3T MRI. No radiation, No hospital stay, no ed, Over 1000 of these have been done in the U.S. A prostate laser center has been set up in Houston texas under that name. In fact you can look it up under that name or you can personal message me and I will give you all the contact info and the doctor who is the director of the center. He has place a portal at that site for anyone to upload with no effort their MRI if they have one and he will analysis the MRI and provide a second opinion or provide a free consultation. That is he does at no charge for this. He spent 3 hours talking to me and my wife so far and we have learned so much. Please do all the research you can but this is a very promising treatment that is the most minimally invasive and little to no side effects. Let me know and I will answer your PM>
I am in conversation with a very good Interventional Radiologist who is treating lower and intermediate PCa in Prostate with a 3TMRI and doing focal laser targeted biopsy and he is also treating the lesions with focal laser ablation for cancer removal. The benfits are termendous with little to know side effects especially no sexual side effects as all of the ablation is mapped out and is done with the real time 3T MRI. No radiation, No hospital stay, no ed, Over 1000 of these have been done in the U.S. A prostate laser center has been set up in Houston texas under that name. In fact you can look it up under that name or you can personal message me and I will give you all the contact info and the doctor who is the director of the center. He has placed a portal on that site for anyone can upload with no effort their MRI if they have one. And he will analysis the MRI and provide a second opinion or provide a free consultation. That is he does at no charge for this. I uploaded him my MRI and he called us. He spent 3 hours in two different conversation talking to me and my wife so far and we have learned so much. Please do all the research you can but this is a very promising treatment that is the most minimally invasive and little to no side effects. Urologists will not mention Focal Laser Ablation. It is FDA approved and it works vey well in these cases. It also improves dramtically BPH symptoms. Let me know and I will answer your PM> Good luck and God bless.
I agree entirely with you.
1) PSA is meaningless relative to having a 3T MRI. Mine was 2.4 rising to 3.5 over a decade, yet the MRI showed an anomaly in the prostate.
2) a MRI guided Biopsy is safe from infection-causing, yet the Gleason score of 8 detected was in fact a nastier 9 from post-op pathology tests.
3) your comments about a Robot-Assisted assisted Prostatectomy being better than radiation are correct. It can be followed by radiation, but after radiation, cell destruction is the thing that stops surgery. Reconnecting the urethra to the bladder is the issue.
4) if my Gleason score had been 7, I would probably have rolled the dice three times until I got the watch and wait answer. I am 70 yo, and reckon the real issue is do I want the extra (say) 15 years. Having just spent a month travelling to car racing events and museums in Germany (I live in Oz) my answer is a resounding yes. I am 9 months post surgery with a zero PSA result.
Hope there is some help in my answer.
Hi Jerald,
If I were you I'd go for the radiotherapy. It is non invasive and these days they can target the cancer very precisely. I am almost through my radiotherapy treatment and have been assured that they can eradicate it. I had a gleason score of 9.5 in all the biopsy samples, so mine was very aggressive. My oncologist said that he would not operate as hormone treatment could keep it under control and even shrink it. Also with an operation there is a chance that some of the cancer cells could escape into the body and as you perhaps know, prostate cancer need not be confined to the prostrate. When my radiotherapy is completed I will remain on the hormone treatment for perhaps two years, or more if necessary. They will monitor it using the PSA test and only revisit it if the PSA rises for three times in succession. You need not "look over your shoulder" - have confidence that it can be cured or if not kept under control. I am suprised you were not offered hormone therapy - my PSA went from 6.5 tho 0.2 after only 2 treatments. Have you explored this route?
Good luck.
Jerald - you don't mention if your Gleason 7 is a 3+4 or 4+3 - I'm sure you are aware that there is a difference.
This is by no means a comprehensive list but some obvious thoughts that come to mind.
Surgery:
Definitive and you find out what your true Gleason score is.
FInd out if there was extra capsular extension with path report
Easy to follow the PSA for recurrence
Peace of mind
Radiation still a possibility if needed in the future
Similar success rate as radiation therapy
Similar side effect profile with side effects manifested early and possibly resolving over time
Radiation:
Multiple visits without truly knowing if the cancer has been irradicated
May or may not still involve a surgical procedure to place markers etc.
More difficult to interpret future PSA's
Possibility of wondering where you stand / less peace of mind
Fewer options for treatment of recurrence - surgery more difficult and/or impossible
Similar success rate as surgery
Similar side effect profile with side effects showing up slowly over time including possible rectal and/or colon cancer
All comes down to the recommendations of your oncology "team" and your own expectations and personality type.
May I ask why you decided in ADT and not active survellieance? I ask because Gleason 6 is low grade cancer which may or may not get worse.
the guidelines don't push any radical treatment for low grade cancers above a certain age, not sure what it is, because it is likely that say a 70 year old with recently diagnosed Gleason 3+3=6 will die with PCa but not from PCa
I wish to add that your point on on robotic surgery in regards to continence is spot on. I had such surgery mid August and am close to 90% of my former continenence. I wear one light pad all day, just in case I leak but don't wear it in bed.
Surgery, robotic or not, is suitable if it is be sliced the PCa
is localised and the patient is considered 'young'.
sorry, my iPad spell checker is playing up.
I meant to say ' surgery, robotic or not, is suitsble it is believed that the PCa is localised and the patient is "young"