Trying to choose between radiation and surgery

Posted by ginger38314 @ginger38314, Aug 9 7:54am

Diagnosed 7/15/26, 2 of 12 cores 3+4 on both 20% and 30%involvement t1c, have oncologist appointment on 8/20 and Urology surgeon on 9/28, asked my main urologist for a decipher test hopefully it reaches the oncologist before the appointment. If it comes in lower considering optional treatments without adt but if not probably will proceed to nerve sparing surgery also if that was the case I was hoping I could get a lower groin hernia fixed at the same time.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

vpaul55 | @vpaul55 | Aug 11 10:02am

In reply to @ginger38314 "I have an appointment at ohsu on 8/20. Ideally would like to do radiation without adt." + (show)

@ginger38314

vpaul55 | @vpaul55 | Aug 11 10:14am

65 yo at time of diagnosis/treatment. I had 3+4 Gleason as well with a PSA 4.6. I chose RT. Treatment consisted of Brachytherapy LDR followed a month later with 25 sessions IMRT. The urologist recommended against ADT in my case. Five plus years since treatments, PSA 0.09. The one complication was experiencing urinary burning for many months due to having both treatments. Best of luck to you.

ginger38314 | @ginger38314 | Aug 11 10:39am

I will definitely consider radiation or seed implants because of my prostate size of 32cc. Had a decipher test done so hopefully they will arrive before oncology appointment on 8/20. Thanks for responding.

hotrod432 | @hotrod432 | Aug 11 3:01pm

In reply to @rickdent "77y/o Diagnosed 5-1-26 Some Gleason 8/8, Decipher .93 In good overall health. Have had Lupron injection..." + (show)

@rickdent
Me? No choice. Radiation only choice. 28 workdays straight.
Surgery considered as first option not recommended for me (age over 70), low platelet count, and in my case, prostate attached to my skin.
The good news, nothing glowing on post radiation PSMA test (gold standard).
We all walk in our own shoes, on our own paths.
Godspeed in your journey!

ginger38314 | @ginger38314 | Aug 11 3:47pm

I want to try to avoid adt therapy so the decipher test should give me a better idea which path to choose.

rickdent | @rickdent | Aug 11 4:47pm

In reply to @hotrod432 "@rickdent Me? No choice. Radiation only choice. 28 workdays straight. Surgery considered as first option not..." + (show)

@hotrod432
I thank all who have been so kind and helpful.. I was set up for radiation and now I feel so much more confident I am on the best course ath for me
Bless you all!!

ikep | @ikep | Aug 12 3:44pm

In reply to @rickdent "77y/o Diagnosed 5-1-26 Some Gleason 8/8, Decipher .93 In good overall health. Have had Lupron injection..." + (show)

@rickdent

At 83, 12 of 12 showed cancer, PSA near 100. Opted for chemicals and radiation. Took a couple of years. Now in remission for about three years. Had to have follow-up surgery to abalate lesions in rectum due to radiation. Piece of cake. ED is given. But at 87 its probably not that inconvenient. Aids like Viagra and injections were not very helpful.

Check with your Dr. - surgery is not always a cure all. My radiation Dr. said she sees a lot of prostate cancer patients where surgery was the first choice, but is back.

amota | @amota | 3 days ago

In reply to @rickdent "@amota Thank you so much for your response. May I ask if you have been on..." + (show)

@rickdent No, I asked my oncologist to suspend it until my PSA rises 1.00. He accepted. Since August 2023 I have been without any medication. I has been on stage 4 since June 2019. Two days ago I had a PET scan because my PSA rose to 0.68. I have not seen the results yet.

ireland1964 | @ireland1964 | 19 hours ago

In reply to @readandlearn "I'm a big fan of surgery. Had a RALRP in Feb 2021. Woke up with five..." + (show)

@readandlearn Did you get the Retzius Sparring procedure done?

ireland1964 | @ireland1964 | 18 hours ago

In reply to @charlesprestridge "@ginger38314 I am in the process of getting ready for treatment. Have been making the decision..." + (show)

@charlesprestridge

@ginger38314

I am in the process of getting ready for treatment. Have been making the decision of RP vs Radiation. I am 61, so younger than you. I have RP scheduled for September 16th. This is over 1 year from initial biopsy in 2025.

Some thoughts:

1. From your information, you do not want to rush a decision. With current information, I would not worry about taking 6-12 months to make a decision.

2. Most important decision is finding (if you haven’t already) a very good Surgeon, Radiation Oncologist, and treatment center.

3. For the surgeon, you want retzius sparing RA surgery. My surgeon converted to this procedure over 2 years ago.

4. To evaluate radiation options, I would want a center and doctor(s) very skilled in SBRT and HDR. I “think, but do not know” Doctors and Centers good at HDR, will be good at IMRT, SBRT, and other versions of Radiation.

5. Piece together as much information possible. Every person is different and unique. You have to understand, best possible, your information.
-PSA velocity over the past few years. Understanding a low PSA may be seen with significant cancer and a high PSA with no cancer.
-MRI imaging. Do you have visible lesion(s)? If so, Pirads rating. My initial biopsy tested at 3+3, but MRI lesion was Pirads5, this led to more tests and 2nd MRI biopsy showing 4 cores of 3+4. Your MRI image may indicate you may likely only have a small percentage of gleason4. With a small percentage of 4, your case may be closer to 3+3.
-MRI imaging to help understand location of lesion. Is lesion (if seen on MRI) showing symptoms of Extracapsular Extension or any other indication of risk profile for cancer escaping the prostate prior to treatment.
5. I sent my information to TULSA Pro treatment center. Due to size and placement of my lesion, I am not a candidate for TULSA Pro. It was a relatively simple process to be evaluated. You want to do understand your options for focal treatment.

At 61, I have chosen RP. Prostate cancer is slow growing. Looking back at yearly PSA results and the size of lesion, my cancer probably started 15 years ago. Cancer starting in my mid 40’s or at least early 50’s has played a role in my selection of RP over radiation.

I have felt, If I was closer to 70, I would be choosing radiation. However, Each person and decision is unique.

Another good tool is to join ANCAN group. They meet twice per month for low and intermediate group. https://mailchi.mp/ancan/ancan-low-intermediate-prostate-cancer-group-august-10th-8-pm-est

Next Meeting is this next Monday night. Join a few minutes early and tell them you are new.

Best wishes as you learn and go through this process.

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@charlesprestridge We have very similar results and age. I'm working on getting that 2nd opinion and most likely will choose surgery over radiation. Hoping I am fortunate to qualify for the Retzius procedure but am unsure how to locate who performs this in my State.
I would like to check into the TULSA Pro option if you have any direction of who to contact for evaluation. May I also ask why you weren't a canidate for this?