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I was just recommended the same treatment by the Mayo Radiation Oncologist, I am really reluctant do do this procedure, and 28 proton radiation treatments! I'm only a 4+3=7 Gleason, and I'm leaning towards no treatment at all. My Decipher was 0.38 so low risk of metastasis, and my PSMA came back clear of cancer outside the prostate.I've done all my homework on all the treatments, and the side effects are just too much risk, I'm 70 years old and would not want to be one of the 10-20% that had incontinence, or ED, I believe I can get 5-10 more years at a minimum, and probably 15 according to the ProtecT study, there is no difference in mortality at 15 years whether you do radiation surgery or absolutely nothing. I did not even like the side effects from the transperineal biopsy, ( blood in urine & semen, temporary ED) so I just can't imagine some of the other treatments. Focal treatments like Hifu Tulsa Pro Cryotherapy also have side effects, the last treatment I have not ruled out is Brachytherapy High Dose, done by Dr. Chang at UCLA, he has done over 1500. Again, I may just do AS and stay on the Ketogenic diet to starve the cancer of Glucose. I am much more interested in quality of life than quantity, and prostate cancer really has no symptoms until the last stage of metastasis in the bone, I have a few other health issues that will probably take me before that. Rectal infections, bladder stricture, wearing a catheter, Urinary incontinence, Erectile Dysfunction, NO THANK YOU, why would I put myself thru that, just to gain a few more years at best, and ruin what has been a fantastic life up to this point. Prostate cancer is big business, billions of dollars and the medical industrial complex is geared up to treat, recommending diet & exercise, doesn't pay much. I would be happy to enroll in a clinical study that takes men with Gleason 7 who do absolutely no treatment, and see how it stacks up. There is no treatment that is curative, even at an early stage like mine, I read all the time about how the cancer returns even after Prostatectomy, then they do radiation and hormone therapy, no thanks. Again, I'm 70 if I was 55-60 I would probably have a different opinion.
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This is in reply to ranger44, and is a bit off topic for this "SpaceOAR" thread.
I too have a low Decipher (0.18, even lower than yours, which puts me in their 14th percentile of risk). They say my "10-Year Risk of Metastasis" is just under 1%, BUT that prediction is only IF I GET WHOLE-PROSTATE THERAPY ( WP radiation therapy or radical prostatectomy).
Although age 78 and with some cardiac issues, the VA's new multi-factor lifespan predictor (https://doi.org/10.1016/j.euo.2023.11.023) says I have a good chance (more than 25%) of living another 15 years. So what to do?
Long-term (15 year) statistics simply don't yet exist for the newer therapies - they haven't been around long enough yet.
Do I treat now to improve my odds while I am healthy enough to endure the side effects? Or do I wait - with active surveillance - and hope for the best. If I go the active surveillance route, and only intervene if and when it becomes necessary, it basically triples my small (2%) chance that I will end up with metastasis (and chemotherapy) in my final years, versus if I treat now.
If my Decipher report tells me what my risk is if - like you - I choose the active surveillance route, I don't see it. (I wish it did, but it doesn't).
It's our choice, with no way to know for sure what the outcome would have been had we chosen otherwise. - in other words, a crapshoot.