Intermediate Risk Prostate Cancer Treatment Decision

Posted by jt14 @jt14, Jun 10 11:08am

I have perused comments in these discussion areas and thought I'd reach out for thoughts on the decision of prostatectomy vs radiation therapy. Thank you in advance for your thoughts.
I am 70 years old in good physical condition (no heart, metabolic or obesity issues). Biopsy showed 5 out of 13 specimens positive ranging as below:
all on one side
Group 1 to Group 4
Gleason 3 + 3 to (just one) 4+4
one with "ductal features"
Most recent PSA 4.8
PET scan negative
I believe from a couple of opinions (top notch institutions)
that mine is fairly aggressive and needs treatment not surveillance.
Except for one surgeon who was adamant that his open surgery would be the best option I have heard that I could rationally choose either radiation or surgery as treatment and I am in that the process now of determining best road forward.
I initially leaned toward robotic surgery ("get it out," benefit of pathological report on the prostate cancer, no long term treatment as with radiation and ADT) but after a recent opinion from a surgeon the thoughts of potentially months of urinary incontinence and much larger chance of ED issues has me rethinking this.
On the other hand weeks to months of radiation treatment and ADT along with the side effects of that and 24-36 months of no/low testosterone and no ability for sex, fatigue, osteoporosis, etc. have me likewise hesitant.
My guess is there is no "right" answer in my case but would very much appreciate feedback from personal experience. Thank you all.

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@capatov

67 year old male with 7.1 PSA and Gleeson 7 (4+3) no way I was choosing open or robotic surgery, Stats show 50% chance of permanent incontinence and impotence. Plus up to 2 weeks with home urinary catheter and drains.

Being treated at leading SE multidisciplinary university health center... I elected three pronged approach:

- 6 months ADT (Orgovyx)
- 23 IMRT treatments
- 1 HDR high dose brachytherapy procedure (17 catheters - direct internal radiation - go home same day)

I feel great. Now 4 weeks post all treatments - except for lingering frequency at night (which gets a little bit better every day) I have no issues. Even ADT has been a breeze - no hot flashes, weight gain, or depression.

I go back for my first PSA blood test in late July - fingers crossed that my numbers are way down

I would strongly recommend the above treatment plan if your HCP feels it is appropriate

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I am glad you are pleased with your decision so far. I hope things continue to go well for you!

I elected RP in a similar situation at a similar age. I also feel pleased with my decision so far. I am now 3 years plus out. They did find cancer at the margin ("positive margin") when they did the pathology, but so far nothing has come of that. I am grateful.

BTW, I am not sure where you got your stats about incontinence and impotence, but I think many would disagree with those statistics. I have had the opportunity to read and research much more extensively in the three years after my surgery than I had in those very quick, rapidly getting up to speed weeks between initial (renewed) concerns about prostate cancer and the decisions that had to be made then.

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@tk192

After talking to 2 surgeons and an oncologist, it seems they all promote what they do as the best treatment. I'm 3+4, .84 Decipher, PSA 5.6, intermediate risk. Surgeons say Surgery gives best LT outcome. Oncologist says why do you think their number one argument for surgery first is you can always do radiation later if it comes back.....just do radiation to start and cure it.

Spoiler alert, Dr. Grim who was a Brachytherapy specialist, says Brachytherapy is best long term. My first surgeon told me they don't do much seed radiation anymore.

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tk192,

what have you decided? my numbers are similar. I am looking at HIFU or Cryo at center of Excellence.

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