Diagnosed At 60 - Radiation Thoughts?

@broderbund1 I researched everything within my limited brain capacity. My urologist actually helped persuade me towards radiation which was a tad surprising but totally appreciated. Then I went down the various radiation choices and simply opted for the quickest and least disruptive to my wife. I did indeed get both DNA tests - on me and on grade 5 tumor. Wanna say it was .49 Should also note my choice of treatment facility was made due to level of comfort with my radiologist & team coupled with the fact they utilize an MRI guided linear accelerator (vs MRI informed). And lastly, knowing that I’m repeating myself, my MRI did indicate seminal invasion, cribriform & EPE (hope I got those initials correct). And it was my choice to not include ADT but that was fully supported by my team. And I’m well aware this totally goes against input by most members of this forum. Peace to all.

@billkmed
You don’t seem to have gotten a hereditary genetic test. It doesn’t come back with a number as a result. If there is cancer in your family, Parents, Grandparents, Aunts, Uncles Then there might be a genetic issue. You can also have a somatic genetic test of your blood or tissue from your biopsy. Both of those can tell whether or not you have genetic anomalies that can get treatment Specific for them.

@broderbund1
That answer is 30% of the core was Cancerous and 10% of it was a four. Time to discuss your options with the doctor, Active surveillance may be an option. Was there something else in the biopsy that changes that?

@jeffmarc yes I did that as well and it was good. Thanks for asking

If your Decipher comes back low then AS is a reasonable option for you. If the Decipher is medium to high then, yes, radiation is a good option to avoid the harsh, immediate side effects of an RP while still retaining low odds of recurrence and good backup plans. See my bio for more info.

@billkmed
At 62 I decided on Surgery. My father had had radiation and died of prostate cancer, so I thought I had a better chance of survival. In my case, it was a good decision because I found out about five years ago. I have BRCA2., If I had started with radiation, my cancer would’ve come back a lot sooner I would not have gotten the 3 1/2 years after the surgery before it came back.

You need to ask your doctor if they can do nerve sparing. As long as they can, then the prostate surgery does not mean you will lose the ability to get an erection. If they take it out without sparing the nerves there is a much larger chance of ED.

If you have radiation, they radiate the whole prostate, which Also destroys the nerves. People that have radiation can usually get an erection for a couple of years and then it stops working because of this. Just some things you need to know.

As @jeffmarc indicated, “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.”

What you want to do (if you choose active surveillance) - is just like I did while on active surveillance - keep it truly “active” by more than just regular PSA monitoring, but also monitoring a half-dozen other metrics so that you can be confident in your active surveillance choice, and you’ll then only have active treatment if and when it’s warranted. (Can you think of any other illness, sickness, or injury where we amputate “just to see”?)

Also, consider other data (like this UK paper in 2019) indicating that initial grade and pathological grade matched 59% of the time, was downgraded just 16% of the time, and was upgraded just 25% of the time —> https://bmcurol.biomedcentral.com/articles/10.1186/s12894-019-0526-9

So, there’s more a likelihood that your 3+4 won’t increase than that it would.

@broderbund1
I was 69 in 2023. My Gleason was 3+4 involving 25% of one core. I chose to have mine treated ASAP.

I did not do ADT but decided specifically on the Mridian radiation machine because it had a built-in MRI versus fused images, with all other forms of radiation machines. That meant that less healthy tissue would be impacted with side effects and quality of life.The Electa unity was the only other one that also had a built-in MRI.

I spoke with five Radiation oncologist all of whom were either trained or at a center of excellence. Only one recommended active surveillance.

However, my PSA was 11.2. PSA’s are a bit tricky for me. My brother had a 6.5 PSA and was treated at Cornell Weill. He ended up dying with multiple cancers that spread but the point was these are educated guesses by doctors not perfect solutions.

Every body is different. There are no guarantees by doctors as to how quickly something may or may not grow in your body. For me, I felt time was not my friend so I moved as quickly as possible through the process. I also had spaceoar, which helps with that separation between the rectum and the prostate to prevent further radiation damage on healthy tissue.

I would absolutely do it the same way I did it except for the biopsy, which I would change to a fusion biopsy.

to broderbund1. I had radiation at 65. My biopsies were similar to yours. I had one 3+4 with 5% with two other 3+3. My PSA was higher than yours, 8.5. 3+3 is a non metastasizing and therefore a strong candidate for AS. I could have gone AS but didn't. Reasons being my PSA was climbing, (5.3 to 8.5 in one year) I didn't want the annual biopsies with AS, plus I had two biopsies that were originally read as 4+3 but were changed by a second opinion at the university hospital. Those changes although favorable for me still messed with my mind. And finally, the radiologist did not requiring hormone theraphy due to my 3+4 being favorable intermediate.

I had photon radiation, mainly because I didn't have an option for proton in the rural area I live, so I never really considered it. I had 28 sessions of 250 Cgy, 5 days a week, with a truebeam machine designed to reduce damage to other areas surrounding the prostate. I did not have SpaceOr because my Dr. felt that there was little advantage in using it. I did have some bleeding and soreness that has subsided. No incontinence or ED from the radiation, although I understand problems can occur years later. (it's been 1 year since my radiation). Surgery to me for my situation seemed to be overkill for the level of cancer found in my biopsies. Plus you can expect incontinence and ED from surgery, at least for some period of time. My decision was made easier when I found someone who went through the same procedure and was doing fine. That was reassuring. Good luck.