How to choose treatment for prostate cancer?

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.

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.

I know what you mean as I went through the same thing in 2014. I almost decided on brac therapy (radiated seeds placed in you) but when I told him I wanted to delay since my grandson was coming to visit. He then told me that I could not have children near me because of the radiation. So then I asked him well what will the radiation do to my other organs and his response was “there is a 95% chance we cure your cancer” my response was I don’t care about my cancer if you damage my heart, lungs, liver or kidneys. Then I told him I was not proceeding and started my research.

I decided on Focal Laser Ablation with the Sperling prostate Clinic in Florida. You may want to look into that they are very accommodating. They were the only people that actually came back with 3 references of patients I could talk to. My first treatment I did not have a catheter procedure was simple, next day I was in the swimming pool having a drink. About 4 years later I had another treatment (at no cost) and that was more intense and I did have a catheter for 5 days.

If your husband would like to talk to me I am open to that. Please send me a private message and I will share my email address. I live in Canada.

The LDR is a 5 - 8 week, 5 days a week treatment. It's not Proton though. One of the Oncologists is recommending that I do the shorter 5 week LDR and then do the newer version of the HDR where you are put under and these long catheters are inserted through the skin into the prostate at several points. Then they wake you and take you elsewhere and at a certain point they hook you up to this machine that introduces temporary high dose radioactive seeds (not permanent) directly into the Prostate.

There are so many side effects, not to mention the invasiveness of the procedure, that I am considering just telling them I would rather go with the longer term LDR alone.

Being that he has had several surgeries and his age I would avoid surgeries and choose the radiation. I had 44 proton treatments at Mayo in Scottsdale, with the 6 month Eligard shot and no SpaceOAR. There is a new alternative to the Eligard shot which is a pill with much less side effects. I am 79 and my urologist told me that his experience with surgeries and older people hasn’t been too good. My GS was 7(3+4). I also had a Decifer genetics test that was worthwhile. Good luck in choosing. Jim

As a result of psa in the .27 range for last 3 months, all my doctors (3 surgeons and 2 radiation oncologists), have recommended 3months on orogovyx( a new adt oral pill) and 36 radiation treatments. I have agreed to this starting tomorrow. What does the group think of this approach.

Jim can you let me know what this pill is. I am on Lupron and I want to take a holiday from it. Thanks