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Radiation + ADT
Like many of you, I am weighing my options regarding surgery vs radiation. 61yo, healthy and active guy. PSA 5.5, MRI negative for any spread outside the prostate, 12 core biopsy with 2 cores 3+3, 1 core 3+4 and one core 4+3. All positive cores were confined to the left part of the gland.
We've had 2 surgical consults and last week met with a Radiation Oncologist. The docs are from 2 major cancer centers. Both surgeons felt that I would have a good outcome but to my age and overall good heath and weight. Surgery and the possible complications still scare the heck out of me......maybe too much reading of internet forums!
Radiation I thought would be more appealing but the RO brought up some points that have me worrying and I would like some input on. My main concern is the use of ADT along with the radiation. He said the standard is 6 mo of ADT and that it would take an additional 6 months for me to get feeling back to myself afterwards. How bad is the shorter term ADT? I am fit, active and working full time and if I am going to feel like crap, lose muscle mass and basically be in a funk for a year, I'm not sure I can handle that. The other issue he brought up that I hadn't really seen talked about is that if you have preexisting urinary issues with urgency, weak stream, etc that radiation will make those issues worse in the short term and potentially in the longterm. I'm on Flowmax now and it does help, but apparently due to the anatomy of my prostate, I am predisposed to having those urinary issues. He said that the urinary issues are greater for the 5 treatment radiation vs the 30 treatment due to the dosages.
I will say I love the idea of the Tulsa Pro, but I don't know that it is appropriate for 4+3 disease. The docs that I mentioned it to are saying they just don't have the longterm studies on it yet, but does that mean you aren't going to recommend new technology without 15 years of data? We would never advance anything if that were the case! I also understand that it is cancer we are dealing with here and we really don't want to mess around.
Thanks in advance for sharing your experiences and giving me some input. Very hard decisions to make as you all know.
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HugInterested in more discussions like this? Go to the Prostate Cancer Support Group.
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Here are some of the posts I have put up.
I chose SBRT with a boost to the tumor and urethral steering to ensure the urethra did not receive excess radiation.
I am now about 5 weeks post SBRT, and starting my third month of Orgovyx. Other than occasional mild to moderate hot flashes I had no Orgovyx or SBRT side effects. I just returned from a two week SCUBA trip, and did 41 dives. If you have more questions please let me know.
Also, have you had a biopsy second opinion, a PSMA PET, or a Decipher done?
https://connect.mayoclinic.org/discussion/one-month-of-orgovyx-completed/
https://connect.mayoclinic.org/discussion/day-8-post-sbrt/
https://connect.mayoclinic.org/discussion/post-sbrt-day-9-15/
http://www.inspire.com/groups/zero-prostate-cancer/discussion/continuing-my-journey-rectal-spacer-and-fiducials
https://www.inspire.com/groups/zero-prostate-cancer/discussion/sbrt-4-9psryn/
Stay Strong Brother
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Hug
1 ReactionSo, here's my clinical history...
I went with surgery...no incontinence, with the use of daily cialis, erections at around the 12 month point.have done 18 months, now ten months through a 12 month stint. Side affects:
As to ADT,
Hot flashes
Muscle and joint stiffness
Fatigue
Genitalia shrinkage.
Weight gain (10 pounds)
Those were "mild" and did not interfere with my life, travel, exercise, work...most on this forum will say that exercising is a strategy for mitigating the side effects.
I did not experience loss of libido nor depression, or bone density loss.
The side effects went away within six months the first time, T began returning within 3 (135 by three, 432 by 6). I am on Orgovyx this time, we shall see starting in April what happens when I come off treatment.
Neither choice is "wrong..." You can do a literature search, generally the overall survival is about the same. Some say the side effects with surgery are immediate then begin to lessen, the opposite with radiation and ADT.
My experience with radiation has been zero side effects, testimony to the skills of my radiation team and the advances in technology, software and hardware used for planning and delivery.
I think something to keep in mind about forums such as this, men who have experienced success in their treatment, tend not to be on them. I have two friends who had surgery around the time I did in 2014, same surgeon, they are PCa free ten years later, see their urologist once a year...
Kevin
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Hug
2 ReactionsSearch the topic: " Has anyone done Proton Therapy without hormonal therapy". I fall in this category and you can review discussion by searching the topic above looking for bandit11 (me) Happy to answer any questions.
I don't know the stats, but from reading this blog for 18 months, it seems a very high percentage of men need salvage radiation after surgery, so they go through both. We went with radiation and ADT and doing well so far. Good luck!
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Hug
1 ReactionHowever if the RP was successful; there would be no need to join Mayo Clinic Connect.
Good point!
My Radiation Oncologist at Mayo informed me that a low risk prostate cancer (which it appears you may have) can go with radiation only. If you have an intermediate risk a 3 month dose of ADT would be prescribed.
I am not an Oncologist, but I think most would call "12 core biopsy with 2 cores 3+3, 1 core 3+4 and one core 4+3" something other than low risk. I had 12 cores with one 3+3 and one 4+3 and was deemed "unfavorable intermediate". What tripped the trigger for ADT (via Orgovyx) was a Decipher score of 0.83. I am currently on my third month of a six month ADT regiment having completed my SBRT Dec 28th.
I would encourage the OP to have a second opinion on the pathology of the biopsy, a Decipher test, and a PSMA PET.
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Hug
2 ReactionsI agree with others here. Get the Decipher test. It makes a difference in the doctors decision. Also, if you do radiation, you might want Spaceoar, Biogel or BioProtect (the newest spacer approved last year). Protect your healthy tissue. Pick a radiation machine that gives you the narrowest margin possible (area outside the prostate). I had the Mridian with 2mm and 5 treatments. 3-6 mm are the normal range. My PSA was 10.2 with 3+4 Gleason.
Some connect because others, struggling with the same decisions, are advantaged by their experience. Thanks to everyone.