1. < Prostate Cancer

SBRT vs. Robot-assisted radical prostatectomy

Posted by dandl48 Dave @dandl48, Jun 11, 2020

Well, my last visit to Mayo didn't go as well as I wanted. I'm 72 years old and I had an Ultrasound-guided transperineal prostate biopsy and the results came back positive for cancer with a Gleason score of 4-3=7 and the Grade Group of 3 which is a Risk Group of Intermediate Unfavorable. With these results active surveillance is out and it's either radiation or radical prostatectomy . If I choose radiation SBRT is available to me using protons for 5 treatments over a 10 day period. The downside of this treatment is I will have to have a 4 month Lupron injection before radiation and that if the cancer returns removal of the prostate would probably off the table. Choosing the radical prostatectomy which would be robot assisted, comes with its own problems, infection, incontinence and impotence. Decisions, decisions, I'm open for your input.

Thanks, Dave

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cmartin65 | @cmartin65 | Jun 21, 2020
In reply to @dandl48 "@cmartin65 SBRT done with a Proton Beam" + (show)
@dandl48

@cmartin65 SBRT done with a Proton Beam

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That's my plan also at Mayo! I'm still debating 5 vs 20 treatments!

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dandl48 Dave | @dandl48 | Jun 21, 2020

@cmartin65 UCLA came out with a good study. They have been doing it since 12/2000. Don't know if posting a link is permitted, but here it is; https://www.uclahealth.org/radonc/prostate-cancer-sbrt

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1 reply
bruto1 | @bruto1 | Jun 21, 2020

EXCELLENT summary. One of the best I've seen. Thanks for sharing.

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cmartin65 | @cmartin65 | Jun 21, 2020
In reply to @dandl48 "@cmartin65 UCLA came out with a good study. They have been doing it since 12/2000. Don't..." + (show)
@dandl48

@cmartin65 UCLA came out with a good study. They have been doing it since 12/2000. Don't know if posting a link is permitted, but here it is; https://www.uclahealth.org/radonc/prostate-cancer-sbrt

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Very good link! Thanks!

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dandl48 Dave | @dandl48 | Jul 5, 2020

Well, will be traveling to Mayo over the Labor Day weekend, 2,200 miles one way, and will be starting the tests and implanting the markers into the prostate for aiming the SBRT machine. In addition DR's will be giving me an endoscopy for my Barrett's and also looking at my liver, believe it or not a liver can develop High blood pressure, go figure. All in all I'll be out there for 30 days. Wouldn't fly these days if it were a free flight.

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bruto1 | @bruto1 | Jul 5, 2020

I admire your commitment to the treatment regimen and respect your decision to stay safe from Covid 19 by driving to Mayo. Long journey, but I'm sure you'll see a successful outcome in the end. Worth it . . . !

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1 reply
dandl48 Dave | @dandl48 | Jul 9, 2020
In reply to @bruto1 "I admire your commitment to the treatment regimen and respect your decision to stay safe from..." + (show)
@bruto1

I admire your commitment to the treatment regimen and respect your decision to stay safe from Covid 19 by driving to Mayo. Long journey, but I'm sure you'll see a successful outcome in the end. Worth it . . . !

Jump to this post

Had my Eligard shot on 7/1/2020 and to date the only side-effect is being more tired than usual. I'm sure that since I said this the hot flashes will be starting tonight or tomorrow.

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vicashd | @vicashd | Nov 7, 2022

I am 45 years old, I have been recently diagnosed with prostate cancer.

My Gleason score is
4+3 = 7
3+4=7
3+3=6
3+3=6
3+3=6
Possible perineural invasion
I am not able to decide if I should get surgery or sbrt

Can some one please guide me through the pros and cons

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3 replies
web265 | @web265 | Nov 8, 2022
In reply to @vicashd "I am 45 years old, I have been recently diagnosed with prostate cancer. My Gleason score..." + (show)
@vicashd

I am 45 years old, I have been recently diagnosed with prostate cancer.

My Gleason score is
4+3 = 7
3+4=7
3+3=6
3+3=6
3+3=6
Possible perineural invasion
I am not able to decide if I should get surgery or sbrt

Can some one please guide me through the pros and cons

Jump to this post

I posted this a few days ago in another thread.

I'll try….but…everyone is different and it's a very personal decision…
diagnosed at gleason 3+4, DRE and MRI showed nothing outside of the prostate, then a full body bone scan was negative for anything there. So working off that information as my doctors basically said, in prostate cancer treatment you have three choices, "watch it" / "kill it" / "remove it". Then they both took "watch it" off the table as the gleason was too high.

Being young(ish, 59 at diagnosis) and otherwise pretty healthy, the surgeon recommended RP. I left that office and went to the radiation oncologist a couple weeks later. He felt, largely for the same reasons, that his option was the best option. That being 40 radiation treatments.

Asking both dr's directly "What would you do if it was you?" They recommended their own disciplines. They were both great guys, very experienced, sit and talk for an hour if you want, I just think they legitimately believed in their own disciplines. What's a guy to do?

I went for the RP for the personal reason that I just wanted the vile tissue removed. I think there was likely a visceral reaction to the "C" word and my brain went to "get it out". My wife felt the same way. Both doctors went down the same list of side effects after treatment with the radiation oncologist adding the " there is a slight chance that the radiation could give you another cancer"

The other factoid that played into it, being a contingency planner type, was what happens when / if it returns. Both doctors agreed that if the RP doesn't get it all, it's much easier to follow up with Salvage Radiation Therapy (SRT) as opposed to working in the other direction. I was told if the radiation treatment doesn't get it all and they have to go to a surgical option later, it's a VERY different VERY specialized surgery. Having said that now, after lurking here for some time, I'm not sure that would be the next step, more likely some sort of chemo unless / until a tumor showed itself somewhere then that would likely be irradiated. (just a guess I really haven't researched that much yet).

Biochemical recurrence came to fruition as after my surgery the surgical pathology report showed that even though the margins were clear (and a lymph node taken and tested for good measure) I had some Perineural and Lymphovascular invasion. The PSA started to sneak up and I went into SRT and hormone therapy (Orgovyx in my case)

I also had a PSMA PET CT scan (with radioactive dye of some sort) that was negative as well, and in retrospect, likely expected to be. I found out from the good folks here that there's only a small change of it finding anything with low PSA, if your PSA is below 0.2, there's only a 30% chance of finding anything even though your psa is on the rise.

Current status, still on the drug for now, PSA last tested at 0.014, no lasting effects from the radiation that I can tell, the only issues from the operation are ED related. I can get semi erect, (not good enough to be of any use to my wife, you just have to be open and get creative) and can get the occasional dry orgasm. Well that was a tad blunt…

Side effects of the ADT are hot flashes, which makes sleeping difficult and "lupron belly" even though I work out and run 8-10 miles a week, and of course, "shrinkage" there are other clinical possibilities, I'll let you look those up. 🙁

One thing I might suggest, if you decide that radiation is the way to go, I might consider some type of protection like Space Oar.
https://www.spaceoar.com/about-spaceoar-hydrogel/how-spaceoar-hydrogel-works/
Best of luck to you!

REPLY
2 replies
melcanada | @melcanada | Nov 8, 2022
In reply to @web265 "I posted this a few days ago in another thread. I'll try….but…everyone is different and it's..." + (show)
@web265

I posted this a few days ago in another thread.

I'll try….but…everyone is different and it's a very personal decision…
diagnosed at gleason 3+4, DRE and MRI showed nothing outside of the prostate, then a full body bone scan was negative for anything there. So working off that information as my doctors basically said, in prostate cancer treatment you have three choices, "watch it" / "kill it" / "remove it". Then they both took "watch it" off the table as the gleason was too high.

Being young(ish, 59 at diagnosis) and otherwise pretty healthy, the surgeon recommended RP. I left that office and went to the radiation oncologist a couple weeks later. He felt, largely for the same reasons, that his option was the best option. That being 40 radiation treatments.

Asking both dr's directly "What would you do if it was you?" They recommended their own disciplines. They were both great guys, very experienced, sit and talk for an hour if you want, I just think they legitimately believed in their own disciplines. What's a guy to do?

I went for the RP for the personal reason that I just wanted the vile tissue removed. I think there was likely a visceral reaction to the "C" word and my brain went to "get it out". My wife felt the same way. Both doctors went down the same list of side effects after treatment with the radiation oncologist adding the " there is a slight chance that the radiation could give you another cancer"

The other factoid that played into it, being a contingency planner type, was what happens when / if it returns. Both doctors agreed that if the RP doesn't get it all, it's much easier to follow up with Salvage Radiation Therapy (SRT) as opposed to working in the other direction. I was told if the radiation treatment doesn't get it all and they have to go to a surgical option later, it's a VERY different VERY specialized surgery. Having said that now, after lurking here for some time, I'm not sure that would be the next step, more likely some sort of chemo unless / until a tumor showed itself somewhere then that would likely be irradiated. (just a guess I really haven't researched that much yet).

Biochemical recurrence came to fruition as after my surgery the surgical pathology report showed that even though the margins were clear (and a lymph node taken and tested for good measure) I had some Perineural and Lymphovascular invasion. The PSA started to sneak up and I went into SRT and hormone therapy (Orgovyx in my case)

I also had a PSMA PET CT scan (with radioactive dye of some sort) that was negative as well, and in retrospect, likely expected to be. I found out from the good folks here that there's only a small change of it finding anything with low PSA, if your PSA is below 0.2, there's only a 30% chance of finding anything even though your psa is on the rise.

Current status, still on the drug for now, PSA last tested at 0.014, no lasting effects from the radiation that I can tell, the only issues from the operation are ED related. I can get semi erect, (not good enough to be of any use to my wife, you just have to be open and get creative) and can get the occasional dry orgasm. Well that was a tad blunt…

Side effects of the ADT are hot flashes, which makes sleeping difficult and "lupron belly" even though I work out and run 8-10 miles a week, and of course, "shrinkage" there are other clinical possibilities, I'll let you look those up. 🙁

One thing I might suggest, if you decide that radiation is the way to go, I might consider some type of protection like Space Oar.
https://www.spaceoar.com/about-spaceoar-hydrogel/how-spaceoar-hydrogel-works/
Best of luck to you!

Jump to this post

Yes kill it with 40 sets of radiation and last 5 rapid arch for margins

Testosterone is the fertilizer for PC so get on Zolodex injections after that and PSA <.01

They took me off Zolodex and it metastases to my L2 lumbar 5 years later needing high intensity radiation to lumbar Back on Zolodex 1.2 PSA Forget sex Save your life

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