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Surgery / Radiation for Prostate cancer?

Posted by curlyo @curlyo, May 28 12:05pm

I have gotten a biopsy done on my Prostate, they took 5 samples.
3 of the cores came back with a Gleason score of 4+3=7 and one was a 3+4=7.
The cancer is still in my Prostate at this point.
I am having a PET CT scan today.
I have upcoming appointments with my oncologist Stockham and my urologist Dr Heslop.
I am 70 yr old and in good health.
Any suggestion on what my best course of action should be?

surgery or radiation

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survivor5280 | @survivor5280 | May 29 12:38pm

First off, nobody here is qualified to tell you what path to take, that is for you and your healthcare professionals to decide, all we can do is tell you our own experience on the matter. Be your OWN advocate, always!

That being said, there's a good chance that with Gleason 7 you might be recommended to start with RARP, although at 4 + 3 you are a bit more aggressive, but without knowing the percentage of each 4 + 3 had cancer then it's hard to know for certain how aggressive it may be. The reason they may start with surgery is due to several factors:

• Your age: at 70, you have a lot more time on your clock and there's no reason to mess around with alternatives when you can recover from the procedure. They tend to start backing off this recommendation if you are a bit older as it's much harder to recover

• Your age (again): Radiation can cause issues down the road and you are probably on that bubble of if you will see that in your natural life. Side effects can include new cancers as a result. My understanding is that this is a big factor in if they recommend radiation off the bat. In my case, at 54, I was told there was no way they wanted to start there.

• Severity: Did you get a Decipher? This will help determine how serious the cancer is, as will that PET scan. If it's severe they may want to do both surgery and radiation.

• Pathology: You don't know how bad the cancer is until the whole prostate comes out and can be examined. At 4 + 3 you are beyond active surveillance but still in the realm of "surgery and done", but the pathology and PET will give you more info

• Back Up: You can always get radiation after surgery, called salvage radiation. This can be reversed and you can get salvage surgery. The difference is that once irradiated they cannot really have a complete picture of what is going on in your prostate because at that point it's just jelly, and the surgery is to scoop it out. But, if you get surgery first then radiation can hit the trouble spots.

This is all to say that I wouldn't be surprised if surgery was the first step. The PET scan is not always done before treatment unless they feel like there's a strong chance of metastasis since PET's are expensive and irradiate you quite a bit. If you were 80+ then I wouldn't be surprised if it was radiation or if you might be a good candidate for alternative treatments such as TULSA Pro.

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heavyphil | @heavyphil | May 30 9:33am
In reply to @survivor5280 "First off, nobody here is qualified to tell you what path to take, that is for..." + (show)
Profile picture for survivor5280 @survivor5280

First off, nobody here is qualified to tell you what path to take, that is for you and your healthcare professionals to decide, all we can do is tell you our own experience on the matter. Be your OWN advocate, always!

That being said, there's a good chance that with Gleason 7 you might be recommended to start with RARP, although at 4 + 3 you are a bit more aggressive, but without knowing the percentage of each 4 + 3 had cancer then it's hard to know for certain how aggressive it may be. The reason they may start with surgery is due to several factors:

• Your age: at 70, you have a lot more time on your clock and there's no reason to mess around with alternatives when you can recover from the procedure. They tend to start backing off this recommendation if you are a bit older as it's much harder to recover

• Your age (again): Radiation can cause issues down the road and you are probably on that bubble of if you will see that in your natural life. Side effects can include new cancers as a result. My understanding is that this is a big factor in if they recommend radiation off the bat. In my case, at 54, I was told there was no way they wanted to start there.

• Severity: Did you get a Decipher? This will help determine how serious the cancer is, as will that PET scan. If it's severe they may want to do both surgery and radiation.

• Pathology: You don't know how bad the cancer is until the whole prostate comes out and can be examined. At 4 + 3 you are beyond active surveillance but still in the realm of "surgery and done", but the pathology and PET will give you more info

• Back Up: You can always get radiation after surgery, called salvage radiation. This can be reversed and you can get salvage surgery. The difference is that once irradiated they cannot really have a complete picture of what is going on in your prostate because at that point it's just jelly, and the surgery is to scoop it out. But, if you get surgery first then radiation can hit the trouble spots.

This is all to say that I wouldn't be surprised if surgery was the first step. The PET scan is not always done before treatment unless they feel like there's a strong chance of metastasis since PET's are expensive and irradiate you quite a bit. If you were 80+ then I wouldn't be surprised if it was radiation or if you might be a good candidate for alternative treatments such as TULSA Pro.

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Great summary, Survivor. Laid out perfectly!
Phil

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