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44yr PSA180 Gleason9 non-metastatic. Surgery or Treatment?
Prostate Cancer | Last Active: Apr 7 9:21am | Replies (172)Comment receiving replies
Hey 4rs…lots to think about for sure - especially being so young and having so much time ahead of you with possible recurrence - a blessing and a curse…
Why the concern with proton vs photon if your pelvic nodes are involved? I understand the thinking about the Bragg effect and surrounding structures not being affected but to my way of thinking you almost want the entire body cavity treated since no one knows if rogue cells are outside the gland or the nodes.
The PSMA lit up the gland and the seminal lining and the nodes, but the concern should be what it did NOT light up.
And the way you are approaching this aggressively drug-wise ( which I applaud!) means you want to leave nothing to chance. Just another angle to consider. Best,
Phil
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In reply to @heavyphil, Memorial Sloan Kettering team in NYC and MD Anderson team in Houston, TX both slightly preferred proton radiation for my case. Mayo urology said surgery; Mayo radiation oncologist said photon radiation. Mayo concerned about cancer cells potentially invading the rectum since I have extracapsular extension near the rectum. Photon will pass through the prostate and “hit” the rectum to cover bases there. MSK in NYC and MD Anderson in Houston preferred proton due to pelvic lymph node involvement - I believe they are concerned about limiting bone marrow exposure due to proximity of pelvic lymph nodes to bone. I have asked them to clarify their specific lymph node concern. MD Anderson did present my case at tumor board - radiation with a SLIGHT preference toward proton (if insurance will cover) was recommendation + hormone cocktail previously mentioned. I had the same thought you raised about photon - it would seem more is better to get all the microscopic “floaters, ” right? Two of the three Centers of Excellence I consulted are leaning toward proton. It’s a tough call…I’m trying to learn as much as I can as quickly as I can. They all agreed the hormone cocktail should shrink the tumor some prior to radiation which will help proton precision. The hormone cocktail will also “sensitize” the cancer cells to radiation (making it more effective) so they want me on that for at least a couple months prior to starting therapy. Additional thoughts?