Gleason 6 (3+3) treatments

I totally agree . A 2nd or 3rd pathology opinion of your Biopsy results .
You treatment decision relies on it's accuracy .

I'm struggling with the decision of what treatment to do for my prostate cancer in the event I need to get treated in the near future. I will determine that in the next few months, after additional test (PSA, MRI, biopsy?). I have ruled out focal treatments. So, I am down to:

1. RP Surgery
2. IMRT Radiation
3. IMRT Radiation with brachytherapy (permanent or temporary)
4. SBRT
5. Proton

I am 60 and have been through 2 transperineal biopsies at Mayo Rochester in 2022 and 2024 (and MRI's in 2022, 2023, 2024). The first biopsy/MRI found a lesion of about 1 cm on the anterior transition zone apex. I had a Decipher score of .17, and a Gleason 6(3+3). So, I went on Active Surveillance in 2022. MRI's in 2023 and 2024 showed no changes and a biopsy in 2024 showed no cancer. Great.

However, my PSA has more than doubled from 3.12 to 7.66. I have BPH and did a partial TURP surgery in July 2024 which helped some, but not a lot. There is a chance I guess that the higher PSA is due to continued BPH issues. I wonder if there is any way to determine this from PSA tests, or some other way. I will have more PSA tests in the coming month, and an MRI.

If it is the cancer spreading, I'm having difficulty selecting the procedure because we like to travel a lot, and the thought of incontinence is very depressing. The quality of life issues would be a serious challenge for me. It seems that RP produces long-term incontinence issues for about 15-20% of men. Radiation produces incontinence after a few years. Also, if I went the radiation route, I still have the risk/issue of the BPH to address. Obviously the surgery would address the BPH as well. I've read all the threads, researched like crazy, but still can't decide.

@dbee
Quite a lot to decide. We have all been your dilema.

I am not sure where you information came from on radiation causing incontinence after a few years. That is not my expereince with information given to me by Mayo urologist, Mayo R/O, UFHPTI R/O. Of course can happen but not a forgone happening.

The radiation can for some cause problems on incontinence, drippling, more frequent urination, vilocity and on an on. Most of these reduce in being an issue over time. I for one had 30 rounds of proton radiation. I am at my 1.5 years since radiation stopped. I did not suffer from incontinence. I did for during treatments and for about a year after have increased urnination, increased urgency, drippling, etc. These slowly got better and better over time.

With all that it has to be your decision. If I could add to what you have posted would be to get a second opinion on your diagnosis and treatment options. That can help you decide. Just remember it is your body, your cancer, what quality of life you want, and your decision to make after seeing all side affects and outcomes of treatment options.
Good Luck!!

Interesting. I haven't met with radiation people at Mayo yet, only a surgeon. What was the main reason you went with radiation? And what gave the edge for Proton? Also, is Proton offered in 5 day SBRT treatments? Was that also an option?

Joe1 have you received any new information from doctors? Hoping you got answers and solutions and are doing well.

Hi,

Yes, I have received new information but it is not good news. I had a new MRI scan done and they found a new tumor that they rated 5/5 on the PIRAD score this time. I had to wait for one month to talk to my doctor as he was away for an extended Christmas vacation. I talk with the doctor via phone tomorrow.

Joe

@dbee
Good morning. Will try to answer your questions. I am not known for brevity but will start trying so if I miss something let me know.

I was given the side affects and complications of surgery and radiation by my PCP, urologist, and R/O. Based on that I did not want surgery unless all my medical specialist were saying was best option for me.

Based on my biopsies, Decipher, PSMA, and bone scan and consultations with PCP, Mayo R/O, and UFHPTI, I was told for me the recommendation would be for radiation as my cancer was in early stages and confined to prostate (at least per the tests).

The edge for proton came from possible complicatins and additional chance of damage to surrounding organs and tissues that photon had over proton. My medical specialist all wanted to make sure I knew that proton and photon success rates for treating cancer were almost identical. The major difference is that photon enters body and exit body. Proton enters body at a lower intensity, releases it radiation at a pre-determined spot and DOES NOT exit body. Thus in comparison the information on proton was the possible reduction in radiation damage to surrounding organs and tissues.

I had the 30 rounds of proton at UHPTI. Mayo Jacksonville recommended 20 rounds of SBRT phton radiation. Neither recommended the high dose to me.

It is my understanding that both proton and photon offer high does options thus far less number of treatments. My Mayo PCP was saying their research was showing increased complicatins and side affects from the high dose versus low dose.

However I have read on MCC many having the high does reduced number of treatments with little to no complications and side affects. I guess from my opinion every ones body is different and everyone reacts in their on personal way to radiation and damage it does not only to the prostate cancer but to surround healthy organs and tissues.

I think I would have considered the 5 day option if was offered to me. I got what they call pencil beam radiation. They did radiate my entire prostate and margins. I asked why radiating entire prostate and margins and was told to make sure we treat all cancer present that we could have missed on the biopsies that is present that we don't know about.

I hope I answered your questions. I can only answer was is pertinent to me, what I had, and what was recommended to me. I would suggest contacting UFHPTI and asking for their prostate cancer package. They wil fed ex to you two books you see mentioned on MCC, a ton of research they have done and got, complete information on their treatments, and can also do second opinions. It is free and no presssure to go with them at all.

I would have done the proton radiation at Mayo Jacksonville but they do not have proton only photon. They are building a new cancer center that will open in 2026 that will have proton radiation treatments for all types of cancer.

Yo tambien tengo Gleason 3+3 y estoy por decidir entre AS y braquiterapia LDR. Tu te hicistes tus pruebas dePSA cada 3 meses? Que fallo en el diagnostico? Que explicacion te han dado? Como re ha ido con los efectos secundarios despues de la braquiterapia?

If I had to do it all over again I would choose active surveillance over low dose brachytherapy. The cancer would have been more clearly defined on MRI making a more accurate biopsy possible. The biopsy needles only hit the edge of the tumor and the seeds were then inserted improperly totally missing the tumor allowing it to grow uncontrolled making surgery and radiation necessary 3 years later.

Side affects from brachytherapy included blood in urine, painful and frequent urination but these all went away in about a month. On the positive side I enjoyed full sexual function and maintained an active sex life until cancer returned and I needed surgery, radiation, and hormone therapy.

Good luck with whatever you choose and don’t hesitate to send me a private message if you need any more direct information.

Hi Joe: First! Always get a second opinion on the issue of prostate cancer.

That said, I had Gleason 3 plus 3 with PSA at 6.47. The cancer was localized with two biopsies to validate the situation. I decided after a month of options (I was in Spain at the time), I selected proton radiation therapy at Loma Linda Children's Hospital at Loma Linda near Riverside, California. Loma Linda was a pioneer in proton radiation therapy beginning initially with children with brain cancer. I spent 2.5 months each morning (weekdays) for low dose radiation. Currently, the time frame is much less due to increase in targeting as I understand it. I have TriCare for Life insurance, so I could go anywhere. I selected Loma Linda because I stayed at March AFB quarters making the housing issue easier. This option you might consider. Maintain your PSA checks is ascertain "velocity" of any changes. Good luck/RH-Florida