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How to choose treatment for prostate cancer?
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!
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First, you need to find out if you have a slow growing or fast growing cancer. Your PSA should tell you. If it goes considerably higher or if it increases at a very fast pace, then choose a treatment/ Otherwise do active surveillance. My Gleason score was a 4+3 seven. I had an enlarged prostate so I chose removal. My cancer jumped to my lymph nodes so I did 44 photon radiation treatments and two years of Lupron injections. I have no energy or muscle. My libido is gone. I wear a depends and have to urinate often. I get very little sleep. I was a healthy 72 year old when it was discovered. I am now 75 with a body that does not work very well. The good news is I am still alive.
new lupron substitute approved my fda 12/20 works faster and better than lupron w lesser side effects
4 surgeon and two rdition oncologists all recommended this course. i did 6 consults. 5/4/21 pet scan was neg they said its more effective when done early. still think i should wait
Here is more information on Orgovyx (relugolix)
- FDA Approves First Oral Hormone Therapy for Treating Advanced Prostate Cancer (Dec 2020) https://www.fda.gov/news-events/press-announcements/fda-approves-first-oral-hormone-therapy-treating-advanced-prostate-cancer
- https://www.mayoclinic.org/drugs-supplements/relugolix-oral-route/description/drg-20506394
A PSA of .24 may not constitute a reason to initiate treatment. What may be useful is additional PSA tests which would provide clinical data of continued progression, calculation of doubling and velocity and imagining with recently approved FDA PMSA scans which could locate the recurrence, these imaging tests can locate recurrence below .5 though as PSA increases, so does the their ability to locate the recurrence. .5 is considered a good "trigger" to image.
Informed by additional clinical data, you can then make a decision, treat, continue to actively monitor with decision points when to initiate treatment and with what.
https://www.mskcc.org/news/finding-hidden-cancer-cells-fda-approval-new-imaging-tool-could-transform-treatment-decisions-advanced-prostate
Kevin
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1 ReactionWith PSA of .27, why do anything but AS
I m post rp. 6 drs. have all said I need to do it
Wow! I have never come across someone with such a low number who went for treatment. I suppose there must be a bigger back story. My latest PSA was 5.4. Gleason is 3+3 and with all things considered, my medical team supports my decision for AS.
Best wishes to you.
Thanks for ur input
I strongly suggest you read this book: "You Can Beat Prostate Cancer And You Don't Need Surgery to Do It" - New Edition
by Robert Marckini | Feb 26, 2020
It lays out all your alternatives very clearly. Good luck.