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I need advice to help make a decision.......
Just to set the background: RARP on September 16. Cancer was intraductal and they found at least 1 lymph node with PC in it. My 6 week PSA was undetectable.
Went to the radiation oncologist this morning. He gave me the choice to start ADT/Radiation (2 years ADT, 7 1/2 weeks of M-F radiation treatments) in January or wait until my PSA starts to go up. His data shows that either option is acceptable with outcomes the same. He also said there is a very slight chance I am cancer-free, but he really is not convinced and is leaning heavily toward PC lurking in me somewhere. He said it is 6 to one, half-dozen to the other.
My thoughts:
1. Both the surgeon and the oncologist are pretty sure that I am NOT cancer-free but right now the PSA is good. The oncologist said that could change with my 12-week blood test.
2. I am leaning heavily toward starting in January. Why wait for the PSA to go up? That means we are allowing the cancer to get large enough to impact PSA levels. To me, that is not acceptable. I don't want the cancer to get a foothold or grow at all.
3. I am a proactive person, not a reactive person. Having the ADT/Radiation therapy sooner rather than later is proactive, IMHO.
4. I am 71 now. As many of us here know, getting older takes its toll on our bodies. I am in good shape, very active, and not overweight. Today, I just cut down three trees, so I'm doing okay. Why would I wait a few years to start when my body is weaker due to the natural impact of aging? I know I can handle it now, but in five years, who knows?
5. He talked about the side effects: fatigue, loss of muscle mass, hot flashes. He said the radiation can also impact bowel movements and urinary frequency. Again, these are also, unfortunately, symptoms of the natural aging process (maybe not the hot flashes).
6. Is the ADT/Radiation regimen that bad that I should avoid it as long as I can?
Yes, I am leaning toward the "do it now" choice, but I want to make an informed decision. I have until mid-December to make the call.
So, if it were YOU, what direction might you take?
Thank you all!!! 🙂
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Wow, what a conundrum….did you have Decipher test or any other genetic scoring? Might narrow it down a bit?
I was looking for a thread to post this short presentation evaluating "new" options from a research clinician's perspective. I'm not sure if it illuminates this decision in any way, but I think it is a nice modifier on our natural desire to find new options offering hope combined with clinical proponents natural desire to push their latest strategy. See what you think....
https://www.urotoday.com/video-lectures/lugpa-2024/video/mediaitem/4423-leveraging-cutting-edge-technologies-to-enhance-prostate-cancer-treatments-presentation-scott-eggener.html?utm_source=newsletter_13589&utm_medium=email&utm_campaign=integrating-new-technologies-into-practice-management-lugpa-2024-annual-education
What lesion are you referring to? Is it in the prostate? If it’s outside the prostate, that is a problem.
And yes, you do have cancer a 3+4 means cancer. It can be very slow growing.
In the process of a Genetic Test . My Bone & CT Scan were both clear .
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1 ReactionThat's a topic to discuss with your oncologist, but since you asked specifically, I'll do my best to answer from my limited understanding as a layperson.
Yes, I'm very sorry, but I think you still have cancer. If they detected it in a lymph node, it's gone past stage 1, so it will likely never disappear from your body (barring future medical techniques and discoveries). Still, you may be able to keep in in check indefinitely until you die of old age, which is the next best thing.
The important questions to ask your oncologist now are how likely is it to continue spreading and how fast might that happen? You also need to ask yourself whether you prefer to err on the side of over-treatment (Damn the side effects! Full speed ahead!) or under-treatment (let's just wait and see what happens). The oncologist will keep your preference in mind while designing a treatment plan.
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3 ReactionsI tend to fall into the camp of - I lean toward quality of life now with close surveillance and if I need to do ADT later then so be it. It’s the ADT that Rob’s the quality of life. I just got through taking it. I understand doing it knowing you have cancer to fight. I’m pretty sure I wouldn’t take it until I have some proof that there is a real need.
Since radiation has a cumulative effect and we are limited to how much we should be exposed to. If you are currently cancer free what would the radiation be killing ?
Respectfully sometimes we are making decisions based on fear of it coming back vs reality. So. Is it a fear based decision ?
Not an easy answer but I do t want further intervention until I need it. Many have many years of remission before they get reoccurrence.
My leison , Gleason 6 , 3+4 =7 or 4 cores at G6 and 2 cores G7 as I said take your pick , is contained within the prostate . Although I am on active surveillance , I am currently weighing up my " FOCAL THERAPY OPTIONS " , of which you know there are several .
At my age I am certainly not rushing into any Surgery or Radiation options with hormone ( ADT ) or chemo treatments . The side effects are worse than the disease
Should I decide on one of the focal treatments e.g NanoKnife , TULSA PRO , Cryotherapy , HIFU , Immunotherapy etc.etc . By the time I experience a potential recurrance I will be 6 ft.. under .
Ah, I probably mixed you up with someone else's reply about cancer on a lymph node. In that case, as far as I understand, there is a very good chance (but no guarantee) that your cancer can be cured via surgery or radiation — the overall survival is about the same for both, though numbers like that tend to be based on old data.
As for whether it's safe to wait, that's outside my experience. I was already stage 4 when they discovered my cancer, so waiting was never one of the options on the table.
Best of luck, whatever you decide.
p.s. The side effects are *not* worse than the disease if it progresses, at least not in my experience. I'd happily double or quadruple my current side effects from ADT, ARSI, and radiation rather than repeat what I went through after they discovered the metastasis on my spine. YMMV.
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5 ReactionsI'm Stage T3B
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2 ReactionsDices "Sus datos muestran que cualquiera de las dos opciones es aceptable y los resultados son los mismos. También dijo que hay una pequeña posibilidad de que esté libre de cáncer,"
Por un lado esta la realidad de efectos secundarios que bajaran tu nivel de vida o que sea aun peor mas adelante o que todo vaya a mejor y no haya cancer. Yo le daria chance a que no haya si te estan diciendo que el resultado sera el mismo si esperas
Yo estoy con dudas parecidas a las tuyas. Es dificil tomar la decision.
Tengo 70 años, Gleason 3+3 bien definido en 5/12, (40%, 50%, 20%, 60%, 15%) todas en el lado izquierdo. En 2/12 permeacion perineural presente. El tacto rectal indico partes duras movibles y la biopsia contornos definidos. Diagnosticado desde 2020 con HPB Grado II por ecografias anuales y PSA a partir del 2020 de +/- 4.6 casi sin variacion en controles anuales. Ultimo examen en agosto 2024 de 4.64.
Tomografia pelvica y torax no indica extension de adenocarcinomas.
Unico sintoma dificultadades urinarias propias de HPB.
¿Que me recomiendan observacion, prostatectomia o radioterapia?.
Solo queda escuchar a los que mas saben, a los que han pasado por lo mismo y luego tomar una decision y encomendandose a Dios con la esperanza que todo salga bien.
Suerte, te deseo lo mejor.
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