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50 and Full of Life. Need advice. TULSA or HIFU or what?
Prostate Cancer | Last Active: 43 minutes ago | Replies (21)Comment receiving replies
@topf My local urologist stated "nerve sparing is possible ...", and that is NOT comforting to me in the slightest. Not probable or highly likely. Possible. I've talked to enough men, including my father, to know urologists don't care if they do or don't spare your nerve bundles. Eradicating the cancer by removing the prostate is their only priority. And I get it, to a point. We need to be our own best advocates, like always. I will say though, prior setting up my consult with Mayo, I had flip flopped from choosing EBRT radiation and hormone therapy to surgery, based on the likelihood I will develop additional cancer in my pelvic region within my lifetime, and I still may opt for surgery in the end.
Thank you for sharing. I'll cross the ED bridge if / when I come to it, but dang I sure do want to avoid it at all costs, if I have other options available, without taking future options off the table.
Replies to "@topf My local urologist stated "nerve sparing is possible ...", and that is NOT comforting to..."
@cxracer One very good sign is your low Decipher score of 0.11 as that indicates a less aggressive cancer. Opposing that is your young age which gives more time for cancer to come back even if it is not the most aggressive kind. As you have witnessed, an RP is going to have big sexual side effects and likely some incontinence issues as well.
If you go the radiation route to get spared of the RP side effects, but still want low odds of recurrence you will need to go very aggressive for the most comprehensive initial kill possible. This would be something like 26 IMRT sessions to the greater pelvic region and either an SBRT or HDR brachytherapy boost to the prostate. Going all in on radiation early though leaves you only with SBRT spot radiation and/or a salvage RP later if there is a recurrence. Of course, there are also newer ARPI drugs that could be used as well.
I was a 3+4 like you at age 67 but with a 0.81 Decipher score and I chose the aggressive radiation route and have never missed a beat in my athletics or sexual life yet. See my bio for more details.
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@cxracer Get a second opinion at Mayo with both, a urologist and a radiologist. The high volume of your cancer may mean that has a high likelihood of EPE. I believe that Gleason 6 cancer can grow locally outside the prostate even if it does not metastasize. These are two different things. If you end up with positive margins after surgery, you may soon need additional radiation. All these are things to bring up with your team.