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Prostatectomy Question? Side effects outweigh benefits?
Prostate Cancer | Last Active: Aug 27, 2023 | Replies (64)Comment receiving replies
Hello all, I was doing research to seek information on what others have done to evaluate this important decision. I was just recently diagnosed with a very rare type of aggressive prostate cancer with mostly gleason 8’s & 9’s and a PSA of 3.5 which baffled the doctors. I’ve been doing regular blood tests and at no point had it gone up or increased.
Bone scan and PETscan came back clean with no signs of spreading. Trying to evaluate my path and like others here have stated, due to the option to have radiation after surgery I am leaning towards surgery. It’s tough to decide what option is best weighing the side effects, but having radiation as a backup seems like a good move as the Surgeon said they will not remove the prostate if we choose the radiation path.
My concern is, if the cancer has spread and so far is undetected why don’t the surgeons offer radiation in addition to surgery for the surrounding tissue now instead of waiting to see where it shows up? Also, since my PSA levels and never been an indicator I may need to do a PETscan or Bone Scan to detect it in the future.
Also, with so much cancer in the prostate can any of the cells escape into the body and land elsewhere?
Thanks in advance. I appreciate reading everyone’s experience here.
Replies to "Hello all, I was doing research to seek information on what others have done to evaluate..."
Would you recommend your path for other future readers? Be honest.
(Cut off; continuing)
undetectable (less than .1)
Post-op pathology confirmed Gleason 9, together with extra prostatic extension (EPE), meaning some cancer cells had gotten out of the prostate, but were found within the surgical boundary.
Proceeded with IMRT salvage radiation treatment to the entire pelvic region (WPRT) including pelvic lymph nodes, together with a short course of ADT , 4 mos Orgovyx.
Looking forward to a good PSA test in November.
Your questions: My lay person understanding is that the current trend is to not radiate immediately following surgery, wait for first PSA reading and then evaluate the status. Also, giving radiation a few months after surgery allows the pelvic region to recover first. It is believed that biochemical recurrence BCR) such as mine indicates residual cancer cells in the pelvic region. My PSMA PET scans did not identify cancer, so the pelvic region is the likely location for cancer cells that escaped the prostate.
Again, I would choose the same path at age 72, now 73.
Best wishes to you and everyone suffering from cancer.
Hi there if you go down the surgery way I would recommend that you get your PSA tested every six month. I wasn't told that if my PSA level went up above 0.01 action needed to be taken but they didn't take any and it was too late for me I am now stage four and it has spread to my lymph nodes. So I hope you take my message on board thank you very much
I had mine removed 11 days ago. Gleason 8, On the Margin too, PSA was 6.9
I did not want cancer sitting in my body so the CAT said no spread as well as the Bone Scan. The Surgeon feels he got it all. Had 1 Lupron Shot 3 mo. and will do that for 12-18 months and have some radiation as well as the Lupron starves any cancer running around and the radiation poisons the rest. i meet with the Surgeon on the 24th to review latest blood PSA and also the Lab on the Margin part of the prostate and also the two lymph nodes that they took. This chit wants to kill like a Great White Shark so be aggressive at your data you shared. You only have 1 life.
So, what my docs told me is that you really can't determine if the cancer has spread until you are in there. All the scans and blood tests in the world won't give them as clear a picture as literally going inside and taking a look. I had robotic surgery so it wasn't quite as invasive as the original method.
And Yes, when in there they found that it had spread. They had to send it all off to a lab to before they made any treatment recommendation. They didn't schedule any treatments until after the results came back. Unfortunately, my cancer was so aggressive that after the results came back I underwent, hormone, chemo, and radiation therapy.
So, if you asked me... let 'em do the surgery (since they recommended it) and be prepared for more news and treatments in the future.
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I chose RP for G 9 & 8s at a center of excellence for a chance at a long lasting "cure".
And I would do it again.
Surgery went very well; clean margins, lymph nodes and seminal vesicles. Continence excellent; ED a work in progress, and coming back.
1st 90 day postop PSA was .19 (and not the goal, which is