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I need advice to help make a decision.......

Posted by chipe @chipe, Nov 18 3:25pm

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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chipe | @chipe | 4 hours ago

I hope this isn't a really bad translation: Gracias por esto. Mi principal preocupación es que, dado que el primer caso de cáncer apareció tan rápido y avanzó rápidamente, experimentaría el mismo resultado al esperar nuevamente. Mi conciencia me dice que empiece más pronto que tarde.

REPLY
northoftheborder | @northoftheborder | 3 hours ago
In reply to @igor1821 "Dices "Sus datos muestran que cualquiera de las dos opciones es aceptable y los resultados son..." + (show)
@igor1821

Dices "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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Las tres opciones tienen ventajas y desventagas.

Observación
pro - riesgo reducido de muerte por efectos secondarios (por ex. infarto de miocardio, diabetes)
con - riesgo elevado de propagación del cancér

Prostatectomia
pro - elimina todo el cancér dentro de la próstata
con - no trata cualquier cáncer que existe fuera de la próstata; efectos secondarios posibles, como la incontinencia

Radioterapia
pro - también puede tratar el cáncer que se ha propagado un poco fuera de la próstata; riesgo reducido de incontinencia
con - pequeña posibilidad de no eliminar todo el cáncer dentro de la próstata; efectos secondarios posibles, como la cistitis o proctitis

Sólo su oncólogo puede recomendar uno sobre el otro pro su caso específico, y la decisión difícil la tiene Usted.

REPLY
jcmacqueen | @jcmacqueen | 1 hour ago

My advice is to do it. Anything to take the upper hand. I'm 69 and I did the brachyboost followed by 5 weeks of external beam radiation. I also am on the ADT regimen which started with Fermagon and then after a month, Luperon every 3 months. PSA is undetectable. There is a price to be paid on a couple of fronts. The ADT will cause hot flashes, which are really no more than a nuisance IMHO. If your married, your wife will chuckle with you. The bigger issue for me is the fatigue. I'm not sure you'll be cutting down 3 trees in a day. I was an avid cyclist, but that has been cut way back. As for the radiation, it was a pretty painless process. Now, after 6 months, I have some bleeding from practitioners, which is a common side effect.
I can tell you I wouldn't have done anything different. Life is a gift and I don't take it for granted. I can live with the inconvenience. Best of luck to you.

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