Recently diagnosed with prostate cancer: What questions to ask docs?

With 40 treatments, am I right in guessing that you were treated with IMRT rather than SBRT or Proton Beam radiation?

Here are a list of things to consider:
1) Request a decipher test on the tissue from your biopsy. This is a step beyond the Gleason score and helps determine how aggressive your cancer is.
2) Give thought to getting a second opinion from a Cancer Center of Excellence. Here's a link:
https://www.cancer.gov/research/infrastructure/cancer-centers/find
3) If your tumor(s) are contained within the prostate, focal treatment is something to consider. These treatments use a variety of ways to kill the tumor(s) without removal or radiation. Look up things like HIFU, cryotherapy, Irreversible Electroporation (IRE), and others.
https://www.medicalnewstoday.com/articles/focal-therapy-for-prostate-cancer
My PSA score that got the urologist's attention was 4.25. A follow-up MRI indicated two tumors. My biopsy showed a Gleason score of 3+4=7 (intermediate risk) and my decipher results indicated low risk, making me a candidate for focal therapy. I had the IRE treatment in January 2024. After the treatment, I had some relatively mild incontinence which has mostly cleared up. I also had some blood in my urine for about six weeks after the treatment, but that has totally cleared up. My PSA in April was down to 1.53. I'm scheduled for a follow-up MRI in August to see how well the treatment worked. My doctor said that if there is an indication that the IRE was not totally effective, I can consider an addition IRE treatment, removal or radiation.

Focal treatment is definitely not for everyone, but with the proper set of circumstances, it would be an alternative worth considering.

Best wishes for a great outcome for whatever treatment you decide upon.

I was your age with 4-3 and 3-4 in one area. I did radiation at Mayo Phoenix with their five proton treatments. My PSA was 2.9. You have to remember if you get 15 years you will be 88 years old. Way different decision than if you were in your 50's or early 60's.

Best to have PSMA PET Scan before going ahead with focal, either surgery or radiation. That is if available.

Correct. My understanding is that Proton is far more acceptable and would have reduced the damage. It was not easily available at the time my treatments were done.

I was treated with SBRT, which is much more specific than IMRT, though not as much as Proton. I did suffer some radiation cystitis and proctitis (symptoms appeared a year later), but it wasn't too serious.

With IMRT, which is more of a blunt tool, I think the goal is to radiate the area around the prostate as well as the prostate itself (though as a layperson I could be completely wrong) — were they concerned about some local spread in your case? If that's true, then surgery probably wasn't an option, since you'd have needed the radiation anyway.

I think the choice for radiation would depend on which kind you're getting and why, rather than just a blanked yes/no decision. For me, surgery made no sense, because

1. I'd just had debulking surgery for the lesion on my spine to try to decompress my spinal column, and I had a lot of complications afterwards (including a prolonged ileus that left me unable to eat for 2 weeks).

2. The cancer had already spread (hence the spinal lesion), so simply removing the prostate wouldn't do much.

3. I was still in a wheelchair, so dealing with the acute post-surgery complications of a prostatectomy would have been very difficult (getting to the bathroom was already a complicated challenge involving transferring to a stair lift).

A lot of people experience very few side effects with SBRT, and they resolve quickly; I was an exception, but no regrets.

If you are in Canada -- PROTRON IS NOT AVAILABLE .

I met fellow PC patients at the cancer center here in Fla. One guy, and his wife, moved down to Fl. for several months from a northern state where proton was not available. They could have gone to a nearer facility in another state but they chose Fla. They rented a condo near the beach and had an unexpected vacation while he had proton treatments.

Some provinces will pay to send patients to the few U.S. clinics that have it, but from what I've read, they generally prioritise pediatric cases (especially if the cancer is near the brain), since the main benefit of proton beam is a modest reduction in side-effects, not an improvement in overall survival.

Solesky, your situation is very similar to mine: last year I was diagnosed with 4 cancerous tumors on the Prostate wall, 3 Gleason 7s and 1 Gleason 8. I was 70 years old with a PSA of 11.9. My urologist, a surgeon, naturally suggested a Prostatectomy but I didn't care for its side effects. Nor did I care for the side effects of his alternate suggestion, Brachytherapy, which includes radioactive seed implants. After much research on my own I decided that Loma Linda University Health in Loma Linda, CA, was my most promising choice. On February 2nd of this year I began my 5 1/2 weeks of treatment, 28 sessions of 60 seconds each, Monday through Friday. I arrived at the Proton Center at LLUH at 7:45am each day, treatments began at 8:00 and by 8:15 I was heading to the Drayson Center for my daily workouts (highly suggested by my doctor and included in the treatment schedule). Some guys chose golf, swimming, running or even pickle ball instead. There were virtually no side effects from the treatment. The entire staff was so concerned about my overall well-being that I almost felt pampered. LLUH lived up to its mantra, "To make man whole", to the nth degree. In early March I 'graduated' from LLUH Proton Beam Therapy. A little over 90 days after my last treatment my PSA reading was 0.014. I strongly recommend you read You Can Beat Prostate Cancer, written by fellow LLUH alum Robert J. Marckini. It will give you the knowledge to make an informed decision about how you, not your doctors, should tackle this beatable disease. I wish you good luck with your decision!