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Surgery? Radiation? Can I have an independent suggestion?
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?
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70 year old. PSA 8.8, Biopsy Gleason 9, predominately right side, PET scan all contained within gland. Chose prostatectomy surgery over radiation. I understand there's no 100% guarantee with either option. Was told by two urologists that if you have surgery and it comes back, you can then do radiation. But it doesn't work the same in reverse. If you do radiation, surgery later is not an option because there is too much burn damage. Plus, for me surgery is more of a one time event, then recovery, and simple life practice adjustments. Radiation drags out any understanding of if it is working or not for some undetermined amount of time. Surgery took out gland, plus right side nerves and lymph nodes. At 70, married for 52+ years to high school love, pecker performance has a different priority these days........today, 19 Jan 25, 11 days, post surgery, leakage is the main frustration, but I expect manageable over next weeks......pathology report just in yesterday. Post op appointment with doc this coming Thu, 23 Jan 25....staying positive....
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8 ReactionsIf you got a decipher test it could tell whether or not your cancer is likely to come back soon. As you know a Gleason 9 is aggressive, but that test could tell you more about your likely future.
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1 ReactionThanks!
Being frozen and not picking one has a worse long-term outcome than picking one of many accepted therapies. I had RP and it work along with my post op erection. I am headed to salvage radiation two years after surgery with ADT. If I knew what I knew today I would have asked if brachytherapy would have addressed this common surgery clean up issue. Gleason 9 Grade 5 Crib 3,4,5 local to prostate.
If you can, I would suggest a second opinion from a teaching research university. They are on the cutting edge (no pun intended) then pick one and go. From my experience with liver disease, a research hospital is much better at statistical analysis which might put your mind at ease when choosing. Best or luck! Let us know which direction you went and how you arrived at that decision. It might help someone else.
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4 ReactionsOn the one hand, I “just wanted it out”. On the other, what I had read didn’t give the warm and fuzzies. I elected for ADT, Brachytherapy and EBRT. It will be what will be. I hope for the best. Currently on Firmagon (the injections are fun); brachytherapy on February 25, EBRT two weeks later for what I assume are multiple weeks of zapping.
Either way that sucker will be dead. Best of luck with your journey!
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2 ReactionsYes. I named it Bill. And I am going to Kill Bill.
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4 ReactionsI was diagnosed with Gleason 7 - 4/3 at age 78. The cancer had not spread outside prostate. I live in Central Illinois and when I Googled prostate cancer, the first two results were North Central University Hospital, Chicago and Mayo Clinic, Rochester, MN. I chose to Mayo's and was given an appointment within 1 week. My first visit With urologist lasted over one hour. He and advised me that due to my age, I was not a good candidate for surgery. My next appointment was with Oncology who recommended 5 Proton treatments to be given every other day (Mon, Wed, Fri, Tue, and Thu.) Each treatment lasted less than 5 minutes. Side effects have been minimal. Treatments finished in November 2024. I might add, Sex has returned after a 5 month hiatus. As a Canadian you may not have Proton available as an option. Subsequent blood tests have shown cancer to be undetectable. Best of luck
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2 ReactionsThere you go again, Hans😂. Best of luck with your treatment. It really does sound like the best course of action and covers all the bases, as we say here in Baseball.
Kill Bill and curse him soundly during EBRT - it really does help the energy flow to all the right places.
Phil
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1 ReactionI feel your pain. Everyone advocates their specialty.
I simply studied the most likely side effects and picked the one with best likelihood of quality of life.
I got three opinions.
I wasn’t in a hurry to be rushed. When I did make a decision I had confidence it would be best for me. I tried and left emotion out of it and looked at risks.
One last thing , I got an Artera AI test and it suggested treatment based on my data. And it matched what I picked.
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