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Pre diagnosis function considerations
My research starting down this road is leading me towards some conclusions to bounce off others here. I have been on AS for about 4 years and this December biopsy confirmed cancer. 3+4 slow growing, low involvement, favorable. Biopsy was random perineal with 12 cores so how conclusive? My psa has been fairly steady but on higher end at 7.5-8.8 range. I feel like it was time to start treating it and seems maybe waiting a bit too long. Back to topic: The last 4-5 years I have had mild urinary symptoms, mild urgency and mild dribbling, decreased stream. Getting up once a night. sometimes not, what I considered aging and could live with. Has very gradually gotten a bit worse over that time. Prostate is somewhat enlarged at 51cc.
So looking at surgery vs different radiation treatments. Seems with some existing but fairly mild urinary issues, enlarged prostate, also throw in my hip implants which complicate imaging for the more advanced techniques, including even psma scans to some extent. Maybe radiation is not as favorable? Anyone one here with similar stats, body parts, some milder previous symptoms that took them into account when making their decision? Thanks , sorry got a bit long.
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One really important thing you left out was your age. That can make a difference between radiation and surgery.
The thing is the long-term results are the same whether you have radiation or surgery. With a 3+4 SBRT radiation Makes a lot of sense and is very effective.
If you have surgery, you might find out that that 3+4 isn’t the same when your prostate is examined. In my case, it was a 4+3 after the surgery. I know other people it was a 4+5 or a 4+4, but that wasn’t seen from a biopsy since they can only access about 1% of the prostate with a biopsy.
It might make sense for you to get a decipher test to see what your chance of a reoccurrence is. If you decide to have radiation that will give you reoccurrence information that a biopsy of your prostate might disclose.
Yes, if you are having urinary issues getting surgery might make things easier. It is however, possible to have a TURP after SBRT radiation to the prostate. That could clear out the obstructions in the prostate that’s causing urinary issues.
If you’re planning on having surgery, you should Talk to your doctor about sparing the nerves. That way, your chance of getting an erection after the surgery is greatly increased.
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1 Reaction@jeffmarc
I am 65 and a decent surgery candidate. My first thought was surgery but have had to postpone for work related issues. It has given me more time to explore other options. Some of the new tech in other treatments are quite attractive than that of surgery. I have checked with proton center and a cyberknife center. Proton would be a challenge even with arc method, The hips present issues with efficacy and predictability. Not what a person wants to hear involving radiation. Cyberknife say they "can " do it and have some experience dealing with these. I have some reservations making a challenging treatment even more challenging and possibly an increased chance of error. It seems from most of posts I have read on here that radiation tends to exacerbate whatever existing conditions in most cases. I have a Decipher test in the works. And I believe my Dr. would refer a pmsa pet scan if it would help with decision.
@mtsenior
Get that pet scan. That can show if the problem is bigger than 3+4. If there happens to be metastasis outside the prostate, then they preferred to do radiation instead of surgery.
Cyberknife/SBRT is quite effective. I know a lot of people who have had it and have been clear for a long time. A low decipher score can really tell you a lot too. Makes radiation more likely to help long-term.
If you’re planning on getting surgery, make sure the doctor can spare the nerves, that way you can probably get an erection after.
I faced a similar decision last year at age 50. PSA 6.68, 3+4 in 6/12 cores, negative PSMA, 0.56 decipher. I really wanted SBRT and took a genetic test (can't remember the name) that showed I wasn't predisposed to adverse effects from short- or long-course radiation treatments. However, two local Radiation Oncologists recommended against SBRT/CyberKnife because they thought it would exacerbate my existing urinary issues - frequency (up multiple times per night), weak stream, and dribbling but no obvious blockage shown in a cystoscopy. I went to MD Anderson for a third opinion - hoping they could do MRI-guided short-course radiation - but their team recommended surgery only and would not even do long-course radiation due to concerns with my existing urinary issues and long-term side effects from radiation. The long-term effects may be less of a concern for you at 65 but have you asked specifically about radiation worsening your existing urinary issues? That was not something I'd really even considered when initially weighing my options.
I ended up have surgery at the Cleveland Clinic in June and have been pleased with the results in terms of speedy recovery, including immediate continence.
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3 Reactions@psychometric
Thank you, your feedback is helpful. I have seen only a few posts mentioning this here. Its good your Drs were on the level. Glad things are on the mend timely for you.
@psychometric
Did the urgency requiring you to get up multiple times at night go away after the surgery? Do you think this is because you couldn’t empty your bladder so it kept filling up giving you the urgency?
Has any doctor discussed what caused the problem initially. You would think that if there is no blockage in the prostate then removing, it wouldn’t change the urgency problem.
@mtsenior You don't mention whether you've had an MRI. I believe MRI is generally regarded as superior to PSMA PET for detecting cancer within the prostate. My urologist used the MRI result to partially guide where to take biopsy cores. PET is the tool for detecting if the cancer has metastasized. I.e. Medicare approves MRI before biopsy, whereas PET is afterwards only if indicated.
When my PSA rose from around 3 to nearly 7 within a bit more than a year, my community urologist ordered an MRI. The result was "highly likely" that "clinically significant" cancer was present. This caused me to accept a biopsy. Since the MRI showed "seminal vesicles involved", the urologist, when he did the biopsy, took several cores from my seminal vesicles.
The seminal vesicle cores contained cancer. Because of this, my case was staged as cT3b, i.e. "high risk", meaning the docs will tend to throw everything in their toolbox at it. Without the seminal vesicle involvement, given the rest of the data available, i.e. PSA below 10 and nothing palpable on DRE, my case would have been staged as "intermediate", either favorable or unfavorable. The treatment proposals compared to "high risk", and the long term outcomes, are quite different.
All the tests leading to a diagnosis are not perfect, even though most people, docs included, use words when they talk about the results that seem definite.
Anyway, if you haven't had an MRI, ask your doc why not.
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1 Reaction@jeffmarc
It has improved greatly, and would probably be a non-issue if I hadn't started drinking coffee again after surgery. My urologist put me on Oxybutynin for overactive bladder prior to surgery (after he did the cystoscopy). He and others thought my prostate was exerting enough pressure that my bladder was overworked and not as elastic as it should be. I should probably quit drinking coffee but...
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1 Reaction@climateguy
I had an MRI not quite 4 years ago. It showed pirads 2, one small bph nodule. So the forward path of AS was chosen. Once again need to note this MRI was degraded, but was felt to remain diagnostic, because of my left hip implant at that date. I have since had my right hip replaced as well , which would further degrade any new MRI results. It may still be an option as they are getting better at refining the process of dealing with artifact involvement, just need to understand the results may not be as definitive. May have to use the dreaded endocoil for better results. I thought maybe a PET may be less affected by my implants but it seems they may also be affected to some degree. Dang replaced body parts are throwing up some roadblocks to try to work around in my treatment research.
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1 Reaction@psychometric
Interesting to hear what the doctors think the problem was. Useful information in case somebody else reports this and I can mention it’s a possibility that surgery was a solution to a similar urinary issue.
Really good to hear that the surgery actually did make a major difference with this problem.