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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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@freed58
Good to hear you only had the 4+3. The 70% 4 is very high. Definitely calls for treatment.
The thing with biopsies is that they only get about one percent of the prostate. If you were to have a prostatectomy, they might find a lot more Cancer than the biopsy found.
With such a minor amount of cancer, focal therapy could definitely be a choice.
Wow!, at 68 I confronted the same situation in 2014. My Gleason was 3-4 (after the surgery it was changed to 4-3).
The neurologist referred me to a radiologist who discussed with me the the outcome of radiation and surgery. He explained to me that the effects of both would be almost the same: erections, therapy, hot flashes, etc. I was convinced to have the prostatectomy. You may decide what is better for you.
@amota
Tough choice. If I may ask, what was it that pushed you to surgery? It’s likely impossible to look back on the path not taken, but, has the surgical path worked out well? Any recurrence since 2014?
Thank you!
@jeffmarc
Good to hear back from you. Interesting new info is that my PSMA PET scan had a relatively low SUV (uptake value) of 3.4. And Decipher test results came back at low risk (0.24). Now, I need to figure out what that all means when pulled together.
@navyvet15
Thank you for your feedback, and Thank You for your service!
I opted for SBRT it's been 4 years since my PSA is 0.5
Was up to 7.4
Doing well except I did get a structure. STRIC--re Autocorrect never let's me spell that. However a balloon dilation took care of it.
Mild irritation when voiding but not a big deal.
Wish you the best.
Egads now I have a kidney tumor 3.7cc they want to ablation on.
Always call it cancer but it's not official
Wheel keeps on turning !
Glen
@freed58 My surgery was 26 months ago. The surgeon was very experienced and well-regarded locally. It was not Retzius sparing surgery of which I was unaware at the time. So yes I had incontinence at first, and ED still, but I am alive. Penis is shorter. BPH issues went away right away. I wore depends at night for a year, mostly as a precaution but don't need them now.
So If surgery, I would definitely look for a surgeon doing nerve-sparing. But if it comes back, I still have radiation as a treatment option.
@freed58 Well, the surgery was needed because the biopsy showed cancer, 3-4 Gleason. A positive margin was left daring the surgery and it manifested on July 2017. The PSA has been sometimes 0.05, the target, but eventually the cancer comes back. Finally, it was diagnosed as incurable in 2019. For 3 years now I have been without any medication, just having been checked every 3 months. The highest the PSA has risen is to 0.84 this August. The medical team decided not to do anything and to keep monitoring the PSA every 3 months.
@freed58
Has anyone discussed active surveillance with you? It is a possibility. Where in the scan was the SUV found? Doesn’t sound very serious, maybe a rib? At the worst, it could be zapped with SBRT radiation..
What are you thinking you would like to do?
@marlon
Thank you for sharing those insights.