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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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I hope this isn't a really bad translation: Gracias por esto. Mi principal preocupaciĂłn es que, dado que el primer caso de cáncer apareciĂł tan rápido y avanzĂł rápidamente, experimentarĂa el mismo resultado al esperar nuevamente. Mi conciencia me dice que empiece más pronto que tarde.
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1 ReactionLas tres opciones tienen ventajas y desventagas.
ObservaciĂłn
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
SĂłlo su oncĂłlogo puede recomendar uno sobre el otro pro su caso especĂfico, y la decisiĂłn difĂcil la tiene Usted.
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1 ReactionMy 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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4 ReactionsHi chipe,
Speaking from a perspective of being diagnosed at stage 4 with bone and lymph metastasis over 8 years ago, I would recommend staying off ADT as long as you are comfortable with it. Once you go down that road, you lose strength and endurance rather quickly. ADT takes away all the testosterone in your body and even if you are later cancer free, it can take years, if ever, for the testosterone to come back. It does not kill all the cancer but makes an environment where the cancer is slowed way down. Once the cancer decides it doesn't need your testosterone any more it becomes what they call castration resistant. Then, only chemo and other more radical methods are needed. Talk with your oncologist about this.
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3 ReactionsDesertsky, thank you for sharing encouraging news. I'm in the same boat as you with diagnosis. For you to post at the 8 year mark gives me hope. I'm only 21 months into this. Hoping for more. It hasn't been a fun ride but at least I'm still along for the ride. Best to all.
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2 ReactionsI was in a similar position. The Psa test is not definitive, it can go up or down. I took the decision to have my prostate removed due to my age etc like you.
Time is not on our side, I found the waiting the first bit, I cannot help you, in the end the choice is yours. I felt that reducing the risk was a better one-off option than having the cloud hanging over till the next test. Good luck in whatever you decide to do.
Actually, castrate resistant doesn’t mean your Cancer doesn’t need testosterone anymore. Many people that are castrate resistant get Zytiga which reduces your testosterone even more and can work for years to keep your cancer at bay.
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1 ReactionVery true, and with metastatic PCa our main goal is to keep the cancer from spreading into new places. My oncologist told me that much of the cancer remains castrate-sensitive even after some of it evolves castrate resistance, so, as @jeffmarc wrote, continuing on ADT and ARSI still makes sense in many/most cases to slow things down.