How to choose treatment for prostate cancer?

Posted by irishpat70 @irishpat70, Apr 15, 2021

It is too difficult for my husband to decide on treatment for Prostate Cancer. We have sought 2 different opinions from 2 good healthcare systems. We have met with a radiologist and surgeon from each and they all say he falls right in the middle to choose either treatment type. I would like to present his stats and find out if anyone can help. He is 71 years old and had quad bypass surgery 10 years ago. He has a knee and hip replaced but otherwise does quite well. His Gleason score is 3+4=7. Removal was his initial reaction but was presented with more possible side effects than radiation. The radiation choices are very different, One is hormone shots, radiation 5 days a week for 6 weeks. The other is so different with 5 total rad treatments and uses some different prep procedures. There would be more prep to avoid rectum damage and gold markers placed to help exact rad placement. How in the world do we know what is best? We are not doctors and know doctors are not gods but should know far more than we do! At least to point toward one option or the other based on past patient outcomes. I just wish I could help him more. Thanking you in advance for your input!

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

Bob Vanourek | @bobvan | Apr 19, 2021

I urge you to read Robert Marckini's book (2nd edition): "You Can Beat Prostate Cancer ...". Amazon link:
https://www.amazon.com/Beat-Prostate-Cancer-Dont-Surgery/dp/1734202203/ref=sr_1_1?dchild=1&keywords=marckini&qid=1618843397&s=books&sr=1-1

Colleen Young, Connect Director | @colleenyoung | Apr 21, 2021

@irishpat70, just checking in. How are you and your husband doing?

irishpat70 | @irishpat70 | Apr 22, 2021

In reply to @colleenyoung "@irishpat70, just checking in. How are you and your husband doing?" + (show)

Thank you everyone for your input. Information is what we value right now. We saw another surgeon and radiologist from another health concern here. We are fortunate to be located where there is a lot avaliable to us. My husband decided on removal by the second surgeon we saw and that is now what is being planned. We have decided weighing all we've learned that this is best for him. Having it removed will give him far more peace of mind. It sure is a tough decision and as with all things the amount of information overwhelming. We know whatever choice is made is to do your due diligence and then make peace with your decision. I can now only support his choice and move forward with being as helpful as possible. Again, thank you for all! I will let you know how thing go. His surgery is scheduled for May 18. God Bless!

Colleen Young, Connect Director | @colleenyoung | Apr 23, 2021

In reply to @irishpat70 "Thank you everyone for your input. Information is what we value right now. We saw another..." + (show)

@irishpat70, one step at a time. And we're here to walk the path with you. When will he have surgery?

Wayne Crosby | @sanway | Apr 24, 2021

In reply to @irishpat70 "Thank you everyone for your input. Information is what we value right now. We saw another..." + (show)

Wishing you guys the very best, a speedy recovery and much sunshine on your journey together.

ken1946 | @ken1946 | Apr 25, 2021

In reply to @sanway "Wishing you guys the very best, a speedy recovery and much sunshine on your journey together." + (show)

I was 72 when I was diagnosed. I chose removal as I had an enlarged prostate causing urination problems. It did not get it all and had jumped to my lymph nodes. I then did 44 radiation treatments and two years of Lupron injections. This has held cancer at bay. I do not have any muscle or energy. I am in a constant state of fatigue, I have no libido. My private parts have all shrunk. My red blood cells are low and I am anemic, I am stage IV aggressive malignant neoplasm of prostate Gleason 4+3 = 7. Good luck with your decision.

johalla | @johalla | Jun 18, 2021

I was recently diagnosed and have a few biopsy samples at Gleason score 3+4 some less and at least 1 at 4+3. After talking to 2 different Oncologists at the same institute I am a bit torn about what treatment path to take.

After seeing the side effect list for Hormone therapy I say definitely not for me. The only decision is do I go for the LDR treatment of 5 weeks followed up by a 1 time HDR or go with a longer LDR only? One of my Oncologists basically said there's not enough data to say for sure that doing the combo deal is all that more effective at this point. Given the procedure details with the catheters and being put under and some possible bad side effects. I am on the fence. The other doctor was definitely pushing towards the combo. I would RATHER just do the LDR but I don't want to screw myself over either.

Colleen Young, Connect Director | @colleenyoung | Jun 18, 2021

In reply to @johalla "I was recently diagnosed and have a few biopsy samples at Gleason score 3+4 some less..." + (show)

Hi @johalla, welcome to the Prostate Cancer group. Deciding on treatment is a cross-road all men face when dealing with prostate cancer. It is the subject of many discussions in this group. For that reason, I moved your question to this existing discussion called "How to choose treatment for prostate cancer?" started by @irishpat70.

You may also be interested in these related discussions:
- Prostate cancer: What treatments did you choose? Results? https://connect.mayoclinic.org/discussion/prostate-cancer-4/
- Anyone had the 5 treatment proton therapy for prostate cancer? https://connect.mayoclinic.org/discussion/anyone-had-the-5-treatment-proton-therapy-for-prostate-cancer/

I'm confident that members like @ken82 @assad4zamani @dandl48 @cmartin65 @waynen and others can share their radiation choices and experiences with you.

Johalla, what criteria are making you tend towards Low-dose-rate (LDR) brachytherapy?

johalla | @johalla | Jun 18, 2021

In reply to @colleenyoung "Hi @johalla, welcome to the Prostate Cancer group. Deciding on treatment is a cross-road all men..." + (show)

Well the LDR is a given. The question really is do I want to shorten that a little and do an HDR after or just do more LDR and no HDR at all.

waynen | @waynen | Jun 19, 2021

In reply to @johalla "I was recently diagnosed and have a few biopsy samples at Gleason score 3+4 some less..." + (show)

I can't advise you on your question, since it wasn't my form of treatment. I had 20 doses of proton beam therapy. I didn't have any reaction to the therapy until after my 5th treatment when I had some pain during urination. I don't think one treatment would have an effect. What I don't understand is that you said a one time HDR. There's a fair amount of prep for the HDR, if they are talking about either Photon or Proton radiation. You have to know the size and location of the prostrate and be able to aim the radiation precisely at the target. Also, they take turns radiating one side and then the other. Not sure how they would ensure that the whole prostrate would be covered. The LDR and HDR are very different types of treatment. It seems like they would do one or the other. By the way, the proton beam therapy is painless and takes less then a minute for each treatment. The only issue may be some urination pain that can be treated. I think the latest photon treatment is similar.
You mentioned that hormone therapy is out of the question. My Gleason score for my worst cancerous cells was 4+4. Yours would be considered medium risk and mine is high risk. Since mine was high risk my doctor at Mayo prescribed 3 shots of Lupron with my radiation treatment. My survival chances increased by 20% with the Lupron. Although you can get by without it, I think the research says it also improves the survival rate for your situation. The hormone therapy does have some side effects but they do go away and at least in my case were tolerable.

Best of luck with your decision. Ask a lot of questions and go with what you feel most comfortable with.