Surgery? Radiation? Can I have an independent suggestion?

Posted by hanscasteels @hanscasteels, Dec 19, 2024

As a Canadian, I apologize in advance for my self-centered question. I have done all the preliminaries and now must make a choice. When asking urologists, they’d advocate for “cutting”. When talking to radiation oncologists, they’d say “radiate” - statistically, the odds are equal or better, and the side effects - well, perhaps, eventually, you might have to deal with those. Which leaves me, as someone reluctant to understand issues related to cancer that I never wanted to know, to make a decision.

In short, here are the parameters: over 4 months, PSA readings of 26, 21, and 25. Biopsy showed cancer in the left nodule, Gleason 3+4 in 5 out of 12 cores. Cribriform and suspected perineurial invasion. Bone scan and CT scan showed no metastasis. PET scan shows a significant uptake (3.7) in the prostate but also, no metastatic activity, except for a minuscule uptake in L4 lumber (but judged to be benign). That doesn’t eliminate microscopic events, I suppose. Also had a prior appetizer of a heart attack and had CABG (9 bypasses).

The question now: what would be an optional approach for me, specifically. ChatGPT says a short course of agonist/antagonist ADT, Brachytherapy, and EBRT. The urologist says “if you want it gone, call me”. The radiologist says “the isotopes are at your service”. How on earth can I make an informed decision that’s best for me if everyone advocates for what they do/know as the best approach?I suspect some answers might be - it depends what consequences you want to deal with - granted. But medically, what gives me the best chance to conquer this, well, shit?

Where would you take it?

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

@northoftheborder

My experience in a big Ontario teaching hospital and cancer centre is that if it's critical, they can move very, very fast — they'll basically sweep their arms across the table and clear everything else off the schedule for you (that happened for me repeatedly in 2021).

If they make you wait, the bad news is that you have to wait, but the good news is that they don't consider your situation to be critical.

If you think you're being forced to wait unnecessarily, every Ontario hospital is required to have a Patient Advocate or Patient Relations Office and you can reach out to them. If that's not satisfactory, you can escalate to the provincial ombudsman:

Email: patientombudsman.ca
Phone: 1-888-321-0339

(I've never had to do any of these things, but it's good to know they're available.)

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Great Advice .
I have had the same experience , as have my associates in Torontoo and Near St. Cathraines . Referrals to both the PMH and Sunnybrook have been " Easy Peasy " .

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@hanscasteels

Agreed. I’ll initiate. Hopefully that won’t introduce another 6 month wait. Can’t afford it.

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Specify who you want referred to . Research the top group of Urologists & Radiation Oncologists at the major hospitals .

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To reiteriate " YOU SELECT THE DOCTOR YOU WANT REFERRED TO . DO NOT LEAVE THIS UP TO YOUR GP OR UROLOGIST .

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@clandeboye1

To reiteriate " YOU SELECT THE DOCTOR YOU WANT REFERRED TO . DO NOT LEAVE THIS UP TO YOUR GP OR UROLOGIST .

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Any recommendations?

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In reply to @hanscasteels "Any recommendations?" + (show)
@hanscasteels

Any recommendations?

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Dr. Bayley or Dr. Gerard Morton Radiation Oncologists at Sunnybrook .
Dr. Laurence Klotz Urologist Sunnybrook .
Dr. Nathan Perlis Urologist Princess Margaret Hospital
Dr Luke Fazio Head of Urology Humber River Hospital also at The Clinic at Beverly Hills in Toronto .
Dr Jack Barkin former Head of Surgery & Head of Urology at Humber River Hospital .
For A 2nd and 3rd Opinion of your Biopsy Pathologyy slides to confirm your Gleason Scores
Highly recommended .
Dr. Linda Rae Kupusta at Gamma - Dynacare Labs . ( Patholigist )
Dr. Srigley also at Dynacare ( Pathologist )
You can Google these names for further details .

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@clandeboye1

Dr. Bayley or Dr. Gerard Morton Radiation Oncologists at Sunnybrook .
Dr. Laurence Klotz Urologist Sunnybrook .
Dr. Nathan Perlis Urologist Princess Margaret Hospital
Dr Luke Fazio Head of Urology Humber River Hospital also at The Clinic at Beverly Hills in Toronto .
Dr Jack Barkin former Head of Surgery & Head of Urology at Humber River Hospital .
For A 2nd and 3rd Opinion of your Biopsy Pathologyy slides to confirm your Gleason Scores
Highly recommended .
Dr. Linda Rae Kupusta at Gamma - Dynacare Labs . ( Patholigist )
Dr. Srigley also at Dynacare ( Pathologist )
You can Google these names for further details .

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Thank you so much!

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There isn’t best or a single answer. Cancer has a price tag. Ugh. Good luck!

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@jerryegge

There isn’t best or a single answer. Cancer has a price tag. Ugh. Good luck!

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Yeah. Starting to realize it. There’s probably “life before” and “life after”. Suspect that these few days prior to commence treatment might be called “the good old days” at some point…

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I totally agree. I had surgery January 2022 at the Phoenix Mayo Clinic. While life has changed, I’m grateful that I’m healthy and still able to enjoy life and help others, especially at Cheyenne’s Regional Medical Center.

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@jerryegge

There isn’t best or a single answer. Cancer has a price tag. Ugh. Good luck!

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"Cancer has a price tag."

Very true in a figurative sense. Fortunately, that won't apply in a literal financial sense for @hanscasteels going to top cancer centres like Princess Margaret Hospital in Toronto.

Having to shell out thousands or tens of thousands of dollars on top of dealing with the challenges of cancer and cancer treatments would be brutal, and everyone in that situation has my heartfelt sympathy.

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