How to choose treatment for prostate cancer?

Tomorrow I will have the first of two HDR brachytherapy at the Rochester Mayo. I know some groups do not offer this as a mono therapy. I had the choice of two weeks of proton therapy or the HDR. I chose the HDR to reduce my travel and not having to stay in Rochester. The HDR for some feels more invasive but I feel like I am in good hands. The Prostate Cancer Research Institute has a good video on HDR Brachytherapy.

Reading this reminds me of my case. First I want your husband to know that he needs to keep up the fight and it can get better! Has he had a psma scan yet to determine where the cancer is located exactly? I chose to start ADT with Lupron shot (6month) and then underwent 30 rounds of radiation. I completed the radiation in December of 2022 and am happy to report that my psa has dropped to 0.12, 0.03 and just this week 0.04. (They retest via blood every 3 months) I am not a huge fan of the Lupron as it changes ones life in ways you cant hardly imagine. Mood swings, depression, hot flashes and loss of sex drive are just a few. I am sure that there are better options available. I stopped after the initial dose and have no regrets. Enough about me. I am concerned more about you and hope that you can get on track and get this fight under control. Please keep us informed on your progress. We are thinking of you. It truly helps to have a supportive partner to help you through. I don't think I could have managed without mine! dls1286

I had Gleason 3+4 and 4+3 scores. I had a PSMA scan showing the cancer confined to the prostate. I bought and read Dr Patrick Walsh’s book on Surviving Prostate Cancer. I had a Lupron shot causing hot flashes - I showed my PCP an article on how Venlafaxine helped reduce/eliminate these for a cancer patient my age. I researched on many prominent websites ( Mayo, John’s Hopkins, Cleveland Clinic to name a few - I even compiled these into a Word document with a Table of Contents which I will share with you - just DM me.) I chose RALP over radiation and the pathology report of my gland showed a previously undetected cancer that would have survived radiation. Take some time to be miserable, even cry; then decide you are the strong one and read all you can. When telling my Urologist of my surgery decision, he agreed and said that, with those numbers, he would have made the same choice. AND I did Pelvic Floor PT before and after the RALP and I had ZERO continence issues. Stay positive and best of luck!

I am 59 and was diagnosed in Sept 22. My psa was 5.7 and because it kept fluctuating my PCP ordered a biopsy, which found cancer in my prostate. I was stage 1 intermediate, Gleason 4+3/7. Genetics testing found it just over the aggressive line. My surgeon relied out surgery and referred my to my oncologist. After reading Walshes book, Surviving prostate cancer, which helps greatly, and after being ruled out for brachytherapy, due to the shape of my prostate and a pubic bone in the way, I was left with radiation therapy and hormones. I eventually choose HDRProton with hormones. I received 2 shots of Firmagon, which was a bitch and one of Eligard before the radiation. I choose the 5 dose treatments, which I finished a month ago. I am also done with the shots. I also has the SpaceOar gel implanted, has no issues with it. No real issues with the radiation either, just trouble with going to the bathroom, I am finally at the point where I have regained control of those functions. My only issues now are lack of strong erections and dry orgasms. I hope that all return when I heal and the hormones where off. I did very well during my treatments. Just waiting now for my first blood test, in August to see what’s what. I know the difficulty in choosing treatment, but at least he has a caring wife, I had to face it alone. I wish you all the besy

What a great partner your husband has.

Just know he and you are not alone. The information out there to select treatments is vast, confusing, and disagreements among medical professionals. It becomes unfair to patient and just adds to the mental stress of dealing with prostrate cancer.

I read books, and searched many outstanding sources to guide me. I faced some real negative feedback from one provider than offended me. It got into costs of proton versus photon, no difference, no benefit, etc. Then you read other providers complete opposite.

One of the books I read said if you go to a provider who does photon you will see that promote that is best and proton they will say proton was better. The provider I chose gave me a briefing on the difference between the two and that I needed to chose what is best for me. I chose proton.

I wish I lived in the areas of Phoenix and Rochester Mayo Clinic as their radiology/oncology do offer proton but many different types and treatment plans. The provider I chose has a physics department that goes over the information and comes up with a treatment plan.

The only thing I can say is have your partner talk on platforms like this. Mayo, Cleveland Clinic, John Hopkins, Cancer Society, NIH, all have excellent information. Just let your partner know he is not alone in his difficulty decided and dealing with all the different opinions. I continue to say that someday I hope that enough scientific studies will be done that allow radiologist/oncologist to agree to recommend what is best for each patient based on their specific cancer and offer all different options available to treat it. Regardless of whether they offer that treatment. They maybe asking too much but it is the patient not the provider or radiologist/oncologist that is important and the focus should be on what is best for each individual patient.

Read Dr Walsh's book on prostate cancer. It might be a bit dated but he talked then about all those things that are out there today. But you sound like me ten years ago. I had high biopsies and digital rectal exams said to get something done. The surgeon I talked to confused me but said to read the book and to get a second opinion. I read the book and called Dr Walsh who gave me a second opinion. He went further and recommended that the surgery be done at Hopkins because when they read the slides, they thought the gleason scores were even higher and there was some contradiction on the DRE's. Oh yes he did a DRE and when the other doctor came in, he did the same. (Dr Walsh no longer did surgery). After that, I stopped worrying about it. Yes, I had the radical proctectomy done at Johns Hopkins by Dr Schaeffer who has since been on National TV telling men to not do the wait and see thing. Dr Walsh has since retired but he was a nice man to talk to. I hope he has a geat retirement. We guys have a lot to thank him for.