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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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Actually, Gleason 8, stage 3. Treatment radiation and ADT only. Mayo Clinic.
My husband, Jim, was informed that he was high risk even though the surgeon said that he was intermediate. What is involved in getting the decipher test? He is dead set on not getting any hormone treatment. They are recommending 18 months of Eligard. He is having the spacer surgery on 3-14-24 and doing the CT and MRI scans on 3-15-24. I presume the Proton Beam therapy will begin the following week. Originally, he was going to do the RP but surgeon said that he had a larger prostate and he couldn't guarantee that he wouldn't be totally incontinent. I think that this terrifies him more than anything as well as the hormone treatment. He is afraid of the side effects that could happen like stroke and heart attack ETC.
The Decipher test is performed on the tissue collected for the biopsy. He does not need to have any additional procedures.
Please remember a lot of what you read on the various forums may be negative in regard ADT as people like me, who after 2 1/2 months so far, that have had minimal side effects are not posting. In general on forums for cars, phones, internet providers....whatever......a lot of the posts are from people with less than optimal experiences.
Eligard is essentially Lupron and is administered via injections that last between one and six months. Perhaps he could go month by month, carefully noting any side effects both anecdotally and through approproate blood tests and stop the injections if he feels it warranted. I would think any amount of ADT would be beneficial as compared to none whatsoever.
These are all difficult choices, and no one can tell him what to do. All one can do is read, study, learn, ask questions and make as an informed decision as possible.
Stay Strong.
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1 ReactionMy story: Biopsy showed two cores one at 3+4. After many consultations I chose RP. One big consideration was that if I chose radiation first and it was unsuccessful, RP is a very difficult second option. RP done in November was a success. I had very few side effects and NO incontinence. I did Kegels religiously. My pathology report came back as 4+5(the biopsy result was incorrect), and the cancer had reached the capsule, but not outside of it. My decipher test showed me at high risk for recurrence. My first post PSA in January test showed my PSA at < 0.01. I’m hoping and praying for more of the same. The bottom line: my cancer was higher risk than my biopsy indicated and I’m glad I got the RP. The Kegels were done religiously and that made a huge difference. Today I am more careful about my diet and exercise daily. BTW, I’m 71 and in great shape for my age. Best wishes whatever your decision! 🙏🏻
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3 ReactionsThank you so much for your wisdom. He reads every post that I give him. Maybe something will click. All of you guys are amazing!
Besides the Decipher test, someone recommended the PSMA test which I think I understand is a PET Scan. He had a regular PET scan a few weeks ago. Will that be the same as a PSMA?
The PSMA PET has become the God Standard for Prostate Cancer as it is much more sensitive than a standard PET.
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1 ReactionHi marlow2,
I’ve taken the Lupron shots every 3 months for 2-1/4 years. Currently on a 9 month break however PSA has risen from 0.02 to 0.04 (prior to treatment 20.0) and testosterone risen from < 12ng to 41. I am concerned about testosterone increase as it is (in my mind, I am NOT a physician) the miracle grow that mutates the prostate cancer cells into the most aggressive prostate cancer cells that “getcha!”. So I see the OncologyNP on 2/12/24 and I am going to advocate for myself to have the Lupron Shots resume, unless she has research demonstrating another pathway. I have enjoyed the break from the Lupron a little more energy, a little more mental “with-it-ness”, not as much emotion on the tip of my sleeve, not as much muscle and joint pain and discomfort, being more present when visiting our children and grandchildren, still a unick in the marriage embrace. Our goal as a married couple when we hopped into the canoe and started down this meandering cancer creek was for greater longevity for me so my wife, whose family line usually lives a long life, isn’t alone as a widow too long. So I did 25 External Beam Radiation Treatments (EBRT), High Intensity Radiation (HIR) and the Lupron shots (ADT- Androgen Deprovation Therapy). I am retired, thankfully, as I had a physically demanding job and could never handle it with the Lupron. God Bless you all,
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2 ReactionsSo, since Jim had a PET scan about 6 weeks ago, will he have to have another PET Scan or the PSMA PET Scan to find out the agressiveness of his cancer?
The PSMA is much more sensitive in detecting metastasis, and if in fact he only had a normal PET scan, if it was me I would say yes.