Deciding between radiation and prostatectomy

@thebeej
With the 3+4 you do have a good chance of being in remission for the rest of your life. Once your prostatectomy is done, they will biopsy your prostate and then you’ll find out what you’re truly Gleason score is, It does change for many people. Mine went from 3+4 to 4+3.

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. Take a look at the biopsy results and see if any of these things were mentioned.

You could get a decipher test, which you could tell you how likely you are to have a reoccurrence and how soon. Some medical systems do that automatically.

My prostatectomy gave me 3 1/2 years before my PSA started rising. I have a genetic problem BRCA2, which is why it keeps coming back. I was 62 when I had my prostatectomy and I was out visiting clients offices four days later. Seven days after surgery, I went back to work full-time as a computer consultant.

Since your father got prostate cancer, you need to get an hereditary genetic test. They are covered by insurance. It could be that you’ve got prostate cancer because of a genetic problem and you want to find out because your children may have the same problem. If you have a genetic problem, there’s a possibility that they have different drugs you can take that don’t work for other people..

It is true for me. ED slowly came on in about 3 years.

I am pushing 70 with a PSA over 9, 4+3=7 Gleason and 17 of 20 cancerous biopsy results. I too was presented with the options of harmone/radiation treatments or prostate removal. I had planned to go the harmone/radiation route until I learned of TULSA PRO. Search the web for Profound Medical to learn more about the procedure.

TULSA PRO, from my perspective, is dramatically less invasive than radiation or prostate removal. It’s a one day procedure and is now covered by Medicare and insurance companies. The rub is that the cancer must be confined to the prostate and there can be no calcification in the prostate. The other challenge might be the location of the hospitals/medical centers performing the procedure as it is still relatively new. I got lucky and have to travel only about 35 minutes to my procedure site.

Search this site for TULSA PRO and you’ll find a group of folks who have already had the procedure done. My procedure is a few weeks out and I am actually looking forward to the procedure as my previous urologist has me on Orgovyx. My new urologist has asked that I continue Orgovyx to keep the cancer from growing any more.

@ray092271, welcome. I bet you're steep into the learning phase of all things prostate cancer. It can be a lot. What treatment options have been discussed with your cancer team? How are you doing?

@colleenyoung

3+4 grade 2, Decipher .46, psa 2.93, bilateral PC.
SBRT, prostectomy using hood technique, nerve sparing. I am 74.
Struggling with SBRT vs Prostectomy using hood technique.
Thank you for any input.

@ray092271 There are a lot of harsh, immediate side effects from an RP that may only improve to certain degrees or not at all. The side effects from an SBRT treatment are most often non-existent or very mild. You can most likely obtain a durable remission (closest thing to a cure) with either treatment (RP or RT) given your mild pathology. Keep reading lots of accounts on this forum from RP and RT guys to get a feel for what generally happens from each treatment. I chose radiation and am really happy I did. See my bio for more details.

@ray092271
SBRT Sure looks like it would be a good choice for you. 3+4 With radiation you have a very good chance of long-term remission.

Of course, if they can spare the nerves with surgery, it would be better than SBRT, which will definitely radiate the nerves resulting in ED problems down the line in a year or two.

Then again, you never know what’s gonna happen with surgery. They do have solutions to the ED problems that might happen with either treatment.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive. I’m just wondering why you got a .46 on the decipher, was something found that you didn’t mention.

Hi Jeff,

Jeff,
Thank you for your information.
The following:
14 core biopsy, 6 positive cores, 5 benign, 2 suspicious
Positive for focal perineural invasion
Focal atypical intraductal proliferation
No definite cribriform pattern 4 is evident in the above
specimens.

Ray

@wwsmith
Started a reply, not sure where it went! LOL!
I liked your Bio packed full of info! My Bio...I am not a social media guy, figured I had to put something about me besides my PC!:-)
Thank you for the detailed bio. Hope to make a decision by first week in April.

Ray