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.

@chamblee54

I 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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What did you select for treatment?

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@packman7

What did you select for treatment?

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I went with beam radiation and 4 mos ADT , but after 3 months on ADT my Artera AI test suggested no ADT so I stopped a month later. Under Dr supervision

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@packman7

I appreciate your comments !
I’m also trying to decide on a treatment at Mayo .
Gleason 3+3 /6
8/12 cores positive for cancer
PSA 16
The team says I shouldn’t do surveillance given positive cores percentage and PSA .
I seem to be leading in your direction of surgery however would like other choices that are proven options . Agree with the comment that the only way to be sure in to remove prostate and identify in actuality what type .
I would ask , What is the most predictable treatment with the best quality of life ???????

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Everyone that did the radioactive seeds plus some radiation ( external) are really Cancer free . One friend had some incontinence but it was temporary and he is still alive and his cancer free did this treatment in 2013 for Darrell my friend so yeah you’re just getting started on. I’m probably PSA. My PSA is probably over 60 right now which I know some can go over 100 but you’re just getting started. Keep fighting ! trust God prayer a lot.

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