1. < Prostate Cancer

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.

bjroc | @bjroc | Dec 27, 2024
In reply to @heavyphil "So this Vanquish utilizes water vapor….sounds like steam. A guy I know had BPH and said..." + (show)
@heavyphil

So this Vanquish utilizes water vapor….sounds like steam. A guy I know had BPH and said his dr was going to use steam; this was about 3 yrs ago so maybe it was similar.
I have not seen him since but I do know that he was not happy with the result and said he might’ve felt even worse. This went on for months and then we lost contact.
Sure hope they improved this technology!

Jump to this post

I think that is Rezum, the steam thing for BPH and not cancer. I don't know enough to compare Rezum and Vanquish but obviously Vanquish is used for cancer so it must differ somehow.

REPLY
CancerFree | @cancerfreekevin | Dec 27, 2024
In reply to @graybeard46 "Cancer free, I’m jealous you’re able to have sex, my surgery was in August, they also..." + (show)
@graybeard46

Cancer free, I’m jealous you’re able to have sex, my surgery was in August, they also had to cut one nerve , I take 5 mg of cialis every other day and 20 mg when I try to get an erection . Even with a pump I’m having no luck which frustrates me more each day . I have a great marriage of 40 yrs and never went more than a few days without love making. Everyone says be patient it not easy with a much younger wife . Just had a pet scan since my PSA was .36 , will find out next week what the next step will be . Plan to try the gel and or penal injection if it’s not too soon to try .

Jump to this post

I definitely understand where you are post op. HANG IN THERE! I was able to achieve an erection the day my catheter was removed and then a month later it went away. Using Trimix was interesting and the self inflicted shots became easier with each injection. From my layman's perspective it helped to retrain the penis just as the body had to be retrained after the prostate was removed.

REPLY
1 reply
graybeard46 | @graybeard46 | Dec 28, 2024
In reply to @cancerfreekevin "I definitely understand where you are post op. HANG IN THERE! I was able to achieve..." + (show)
@cancerfreekevin

I definitely understand where you are post op. HANG IN THERE! I was able to achieve an erection the day my catheter was removed and then a month later it went away. Using Trimix was interesting and the self inflicted shots became easier with each injection. From my layman's perspective it helped to retrain the penis just as the body had to be retrained after the prostate was removed.

Jump to this post

Thanks for hope that my normal life can return

REPLY
1 reply
CancerFree | @cancerfreekevin | Dec 28, 2024
In reply to @graybeard46 "Thanks for hope that my normal life can return" + (show)
@graybeard46

Thanks for hope that my normal life can return

Jump to this post

I may sound like a broken record so I apologize in advance. I was right there with you and what I knew was the first priority was to remain on this side of the dirt. Next was sexual health and continence, as never needing to wear a Depends at least until I'm much older was an equally big goal. So sticking a needle in my penis was never an appealing option BUT I turned it into a comical, joke filled mental dynamic. I never mentioned the hilarious, yet respectful conversation I had with the young nurse who showed me how to use the needle...nor will I on this site. That said, ED drugs like Sildenafil never worked for me. Not sure why but I have a low resting rate, 47-51bpm, and that drug only served to make me feel light headed.

MAKE IT HAPPEN!

REPLY
1 reply
bobbygene | @bobbygene | Dec 28, 2024
In reply to @bjroc "Brachy sounds good as a choice, not sure, as I had BPH so it was not..." + (show)
@bjroc

Brachy sounds good as a choice, not sure, as I had BPH so it was not an option. Another option is Tulsa. There is also Vanquish at some clinical trials

Tulsa
https://tulsaprocedure.com/find-a-tulsa-pro-center/
https://tulsaprocedure.com/
If wondering about Tulsa Pro from a science point of view, here is a basic Tulsa science overview article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9231661/
Conclusions:
“As an alternative to conventional treatments, TULSA is safe and effective for prostate tissue ablation in men with primary PCa. There is also evidence that TULSA delivers effective relief of urinary symptoms while treating PCa in a single, low-morbidity procedure. The likelihood of freedom from additional treatment or potency preservation is associated with the planned ablation fraction.”
Tulsa or HIFU - what is the difference

Tulsa Pro uses some of the same ultrasound technology for the ablation as HIFU, but they are not alike. Tulsa Pro can handle a person with a fair amount of BPH, HIFU cannot. HIFU the lesion has limited locations that it can reach so the lesion is best if it is near the rectum, as it is done that way and only reaches a limited area in the prostate. There are other limits some places put on HIFU, and some places put limits on Tulsa too. These are limits the maker of the equipment has not put on using it, as the places doing studies almost always put more limits on who they accept. So bottom line is if you go to a place that is part of a study they may not accept you for TULSA or HIFU or Vanquish, where-as a private physician might. Meaning get multiple opinions.

----
Vanquish
Something new and an alternative to Tulsa, can't speak myself to it, just to Tulsa. But it is something to read on if you are studying what to do.

Trials
https://clinicaltrials.gov/study/NCT05683691

Jump to this post

I had the TULSA PRO procedure at the end of Nov. It was easy and almost painless except for my hips due to the position they had me in. I wore the catheter for two weeks with no problems. I had to go to OU Cancer Center in OKC, 4 hr. drive, for treatment. Locally I was only offered surgery or beam radiation. I did research and settled on TULSA and I'm happy I did. Dr. said he got all the cancer. I had 3 cores and classed as intermediate. PSA increased from 6.4 to 7.5 within two months so I decided to have it treated instead of worrying about it.

REPLY
graybeard46 | @graybeard46 | Dec 28, 2024
In reply to @cancerfreekevin "I may sound like a broken record so I apologize in advance. I was right there..." + (show)
@cancerfreekevin

I may sound like a broken record so I apologize in advance. I was right there with you and what I knew was the first priority was to remain on this side of the dirt. Next was sexual health and continence, as never needing to wear a Depends at least until I'm much older was an equally big goal. So sticking a needle in my penis was never an appealing option BUT I turned it into a comical, joke filled mental dynamic. I never mentioned the hilarious, yet respectful conversation I had with the young nurse who showed me how to use the needle...nor will I on this site. That said, ED drugs like Sildenafil never worked for me. Not sure why but I have a low resting rate, 47-51bpm, and that drug only served to make me feel light headed.

MAKE IT HAPPEN!

Jump to this post

Thanks

REPLY
1 reply
bobbygene | @bobbygene | Dec 28, 2024
In reply to @graybeard46 "Thanks" + (show)
@graybeard46

Thanks

Jump to this post

Two weeks after my TULSA procedure I returned to have my catheter removed. The girl couldn't get the tubing apart. I suggested she get some sizzors. She returned with another nurse. There I was with my junk out and three women observing while we tried to separate the tubing while I was holding on to the tubing so it wouldn't pull. Finally success and out it came. A little embarassing but not that much. I was just glad to have the catheter removed and I could pee.

REPLY
View MoreView Less
Please sign in or register to post a reply.