Surgery or Radiation + Hormone Therapy

Coul you cite the study that did this?

They gave testorone to three people for 10 weeks and one of them their prostate cancer got worse and died, That deserves thee Nobel about as much as Obama

This is my first comment. I’m a hot mess and need help from all of you. So here goes. 71 years old. PSA score went from 5 to 17.1 in two years. Biopsy shows right prostrate has cancer (Grade 5) with a Gleason score of 9. CT scan and Bone scans doesn’t show any cancer outside of the prostrate (thank goodness). I have Factor V Leiden (blood clot chromosome). My question to all of you nice folks is risk surgery(bleeding or blood clots), radiation, or something else? Thanks

Sps488: for me, there was a grieving process, sort of a death of health and cancer is very scary. Once your past that stage, you look for solutions which is great that you are here now. Lots of good information from people going through it. I have made a number of comments about my recent experience with radiation and the MRIdian machine, https://viewray.com/, which you may want to add as a radiation choice. When you get a biopsy, use the biopsy material for a decipher test to test aggressiveness, https://decipherbio.com. Consider spaceoar for rectum
Rotection. Radiation margins are important.I am 69 and just finished my 5 treatments. Minimal side effects were urine flow Slowed and handled by Flomax. Keep reading the comments on this site.

sps488: Very sorry to hear of your recent diagnosis.

Surgery or Combination of Radiation & ADT hormone therapy are the gateway choices.
72 years old and I chose radical prostatectomy performed last September at a center of excellence for prostate cancer.
Incontinence and erectile dysfunction (ED) are the most discussed side effects of surgery. Fortunately, I had no issue with incontinence; ED is a different story and a work in progress.
I am glad that I chose surgery.
Many on the Mayo Clinic site have had different forms of radiation, and most I think also had ADT, and seem pleased with their results.
Interestingly, long term results, I believe, are similar for surgery or radiation/hormone therapy.
Does your blood factor issue impact your available choices?
Recommend Prostate Cancer Foundation (PCF.org) very good, free book on Prostate Cancer and treatments, available as a hard copy or downloadable.
Also, Patrick Walsh's book Surviving Prostate Cancer is a great read and resource (note 4th edition 2018 and some protocols have evolved).
Best of luck with your battle with this insidious disease.

Thanks Ben1 and Michael Charles for your comments. I have scheduled with a Radiologist this Friday to discuss this option and I have an appointment with my Urologist next week to discuss the surgery option. I will have more information and questions after next week. The Factor V Leiden complication is I will have to go off my blood thinner (Eliquis) for several days and blood clots can reoccur. I already have blood clots in my left leg so I think about that a lot. Thanks again for the comments. Keep them coming. I need the support and information right now.

@sps488 If going off your blood thinner is a concern, I would be leaning quite strongly toward radiation since I'm quite sure you keep taking all your meds while being treated. I did.
Good luck, I will say whatever you choose you will probably suffer from "Buyer's Remorse" after it's done, thinking why I didn't choose the other option.

My husband is diagnosed with prostate cancer with gleason score of 6 but perineural invasion shows cancer spread in 16 pit of 17 cores. The urologist initially recommended monitoring but when we questioned regarding perineural invasion and risk of spreading the cancer outside he advised surgery. We also met a radiologist who advised surgery. We are in Canada and talked to another radiologist in USA. Who highly recommends radiation and assures us that there are no side affects associated with it as compared to surgery and the chance of recurrence is less as compared to robotic prostectomy. And if it does recur a surgery can be performed at later stage. We are so confused. Please guide.

The information that I received from several doctors at UCLA is different than what your US doctor has told you. I am 77 Gleason 9 aggressive, CR. They recommended robo surgery because, radiation practically removes the option of surgery later, but surgery does not remove the option of radiation and surgery allows a better review of the prostrate and therefore a more complete diagnosis / treatment plan. Surgery is the gold standard. Surgery and radiation are equally effective for the initial treatment but after initial treatment the cancer often returns. I had surgery, one day in the hospital, one week with a catheter, continent, ER. Had 13 months of ADT and Erleada. I believe that I made the right choice. Good luck.

I believe you're likely getting good advice from different folks, it's just that there should probably be some fine tuning....

A) It's my understanding that if you get treated via radiation, and there is a recurrence, the surgery is very specialized and difficult at that point. Whereas if you get the surgery, and recurrence happens, radiation is the second treatment (likely with ADT meds) and there is often little or no damage from the radiation as it's at lesser levels than if it's the primary treatment. Ask your docs about this.

B) There may certainly be side effects from radiation, they just may not be a bad or long lasting as from surgery. (fatigue, damage to the colon is possible, diarrhea cramping etc.). They should subside a couple months after end of treatment. Some folks report no side effects, who knows for sure? It also depends on the type of radiation.

I can see both arguments. Part of the radiology argument might be coming from the perineural invasion. Some might say that taking prostate out at that point may be "shutting the barn door after the horse got out." BTW, I was unaware that they can make that determination from the biopsy, learn something every day. The fact that you are showing as a gleason 6 may also play into this. I might also want a bone scan and MRI to see you can find anything elsewhere.

FYI, I consulted a surgeon and a radiation oncologist before deciding, both said that if they were me they'd go with their specialty. So they both probably believe what they are doing is the best way to go about it. You'll have to educate yourself as best you can, (do a lot of reading here) and decide what's best for you and your family.

Was the radiologists just that or a radiation oncologists? I'd be seeking the advice of the latter.

I ended up with surgery followed by salvage radiation therapy. I also had perineural invasion but it wasn't discovered until the pathology report after surgery.
Just some thoughts.
Best of luck to you!