Diagnosed At 60 - Radiation Thoughts?

I consider myself to be a young & fit 67 year old and was recently treated for 3+4 via SBRT X5 with Barrigel insert. It’s already been 8 months and if I had to do it all over again - I would not change a thing. Side note: cribriform was present, but no ADT prescribed. Best of luck with your journey- you’ve got this

What other information was given with the biopsy to indicate risk?
Did they give the % of 4 (55% 3 and 45% 4 worse than 90% 3, 10% 4 but both 3+4). Sounds like this a fusion biopsy where all 3 cancer cores were from the target and the random samples were benign? Decipher score will help.
Doctors tend to recommend what they know so expect urologists to favor surgery and radiation oncologists favor radiation with age 60-75. Could also look at a focal treatment even though these have higher reoccurrence rates since that will not preclude RP or radiation later.

@jim18

(3+3) was 10% Total Core .2 cm
(3+3) was was 25% Total Core .3 cm
(3+4) was 10% Total Core .4 cm

You’re having only one 3+4 with very low percentage does imply that active surveillance could be your best choice. The only issue is that many people with 3+4 find out after a prostatectomy that they had higher Gleason score results following the biopsy of their prostate. In my case, I was a 4+3 after surgery, I know other people That were 4+4 or 4+5 After surgery. This isn’t something you can find out from radiation.

It is more likely that you do not need to do anything now, You might ask what percentage of that 3+4 was a four.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Here are some videos on active surveillance and why you should pick that over other treatments

Here is a video with Dr. Laurence Klotz, one of the experts on active surveillance. He can give you answers as to why you would or would not be a good candidate for active surveillance.

With just a 3+3 and 3+4, of all possible Gleason scores - 6(3+3), 7(3+4), 7(4+3), 8(4+4), 8(3+5), 8(5+3), 9(4+5), 9(5+4), or 10(5+5) - your Gleason scores are the lowest. You’ll be around for a long, long, (long, long) time. You have little to worry about in that regard.

Regarding your comment “… but also want to live to see my grandkids and hopefully enjoy retirement…,” the data regarding surgery vs radiation indicate that success rates comparing surgery with radiation are statistically equivalent: (https://www.nejm.org/doi/full/10.1056/NEJMoa2214122), it all comes down to side-effects and quality-of-life (or as that paper concludes, “… the choice of therapy involves weighing trade-offs between benefits and harms associated with treatments for localized prostate cancer.”).

I was on active surveillance for almost 9 years. For me, the mental aspect played no part at all; as long as my numbers were good, I was good staying on AS. The key is to track more than just your PSA; as long as you keep your AS truly “active” you’ll do well.

Yes, use your time on AS to learn all you can about prostate cancer, diagnostics, treatments, etc. Become a “student of prostate cancer.”

More often than not, urologists will have a “strong recommendation” for removal; more often than not, radiation oncologists will have a “strong recommendation” for radiation. But, it mainly comes down to you and what side-effects you’re willing to deal with and quality-of-life you want.

I was diagnosed at 56y/o, was on AS for about 9 years, had proton radiation treatments + 6 months of ADT at 65y/o. Now at 70y/o, still enjoying retirement and have 3 grandkids. My choice of radiation was the right choice for me.

There are no limited salvage options if radiation is done first. The old-school thinking that “if you choose radiation first, you cannot have surgery later” has some truth to it, but it doesn’t consider modern treatment techniques. If there is local recurrence after initial radiation, choice of treatment would depend on the nature of the recurrence; there are options - focal therapy (e.g., cryo), brachytherapy, SBRT, and yes even re-radiation in some cases; salvage surgery is a far distant option.

It’s not about “Would radiologists consider you a strong candidate?” Or “ Would surgeons consider you a strong candidate?” The only question to be answered is “What do you want?”

With what I know now after having been on this journey for 14 years, I would make the same choices again (except these days I would also have PSE tests, transperineal biopsies, and PSMA PET scans to provide me more information.

@broderbund1 Those are the % of core that was cancerous, not % that was type 4; Gleason rules require at least 5% to count as a separate type so a 3+4 could be 95% 3 and 5% 4 up to 55% 3 and 45% 4. With 3+3 the % are the same since at least 96% was type 3. The less type 4 the better for AS.

@jim18

I had a 10% pattern for (3+4)

@billkmed

Interested in your decision making process here ……did you feel pressure to have surgery given your age from your Docs?

Also ….. did you take a Decipher test ?

@broderbund1
You wrote this the first time. You can ask the doctor what percentage of four was in that 10% of 3+4.

@jeffmarc

Here's the exact verbiage from the biopsy

......Gleason Grade 3+4, Score 7, Grade Group 2, Percentage of Pattern 4: 10% Maximum linear measurement .4 cm 30% of total core biopsy tissue.