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Surgery or radiation?
I’m sure questions like this have been raised here before, but I welcome your inputs.
I am an otherwise healthy 68 year old with a BMI under 21. A 20 core biopsy randomly found a single positive core graded as a Gleason 4+3. Core is defined as located in the left lateral apex. My PSA is 4. My prostate is 73g. My PSA density is 0.055. I do have BPH and a weak stream. PSMA PET verifies cancer is contained to the prostate. Decipher test and pathology 2nd opinion in process.
The docs I’ve seen in northern Virginia area say to pick your treatment path. They’re both reasonable but carry different pluses and minuses. They did say if I picked radiation I’d first need an outflow procedure such as TURP or HoLEP.
I welcome your inputs from your experiences.
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@charlesprestridge
A bit more info:
MRI showed one lesion which turned out benign. The one positive core was found randomly. 80% non-benign with 70% given a Gleason 4. So, overall Gleason was 4+3.
(Intermediate unfavorable)
Decipher test ordered.
2nd pathology review in process, too. Waiting on those redults.
Thank you for your suggestions and questions.
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2 Reactions@freed58
You don’t mention if other things were found in your biopsy. There are some very important things that could be found that change the direction you should pick for 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.
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1 ReactionSurgery and radiation both work and have comparable overall survival stats but different potential side effects, so choose your weapon for the duel.
Also note that if they do find any spread beyond the prostate, surgery is usually off the table (so to speak).
Best of luck! There really is no slam-dunk case for either over the other, so it's a very personal choice. It might even come down to who you like more, your radiation oncologist or surgeon. 🤷
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2 Reactions@jeffmarc
I appreciate the question. Just reread the biopsy report. There’s no mention of any of the expressions you noted in your reply. It simply made reference to “prostatic adenocarcinoma, Gleason 4+3=7 with 70% pattern 4 involving 1 of 1 core (80%).” All 20 other cores were noted as benign prostatic tissue.
Not sure if it was already mentioned but, the book “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh will help clear things up a lot.
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2 ReactionsI was 67, 4+3, given the same options. I chose surgery because I wanted it out. I was glad I did, as it turned out the cancer was more aggressive than they could tell from testing. Side effects for sure, but I decided the potential radiation side effects were not insignificant either.
I would love to know what you decided. I just got my results today.
14 cores.
1 Gleason 7 4+3 70%
2 Gleason 7 3+4 10%
3 Gleason 7 3+4 10%
11 others negative
PSA 5
41mg size
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1 Reaction@marlon
Thank you for sharing. Would you mind sharing how long ago was your surgery, how well have side effects diminished thus far, and what you knew of the surgeon’s expertise and volume of same procedures?
My PSA drastically jumped after hitting 4.0 in the matter of months. I chose surgery as I wanted to make sure it was all removed. My surgeon performed a biopsy on my bladder and scared me to make sure there wasn't cancer anywhere else. If there was, then the only option would be radiation. I've had some setbacks due to the surgery but nothing major or unexpected. Every three months I'm rechecked. It's been 10 months still no indication of C. I'm a couple years older than you and loving life. Good luck!
@navyvet15
Scanned not scared