Prostate cancer treatment options?

kjacko: I had 3+4 as well last December with a 10.2 psa. I am 70. I had multiple opinions from radiation oncologists and narrowed down my radiation choice to either the Mevian proton therapy or the MRIdian Linac machine from viewray. For me, prostate removal was not a viable choice as I considered the quality of life risks to be too great. I had the decipher test which measures aggressiveness and IS used by doctors as one component of decision making so you may want to ask about that as well ass the specific radiation machines.

You want to protect healthy tissue so it helps to ask about the margins used in treatment (the mm outside of the prostate that radiation will expose healthy tissue to). The MRIdian uses 2 mm vs others that use 4-6 mm. I had 5 hypo fractional treatments and finished them in February. Most of the Dr's say the same thing which is that the outcomes are the same regardless of your choice with tolerable side effects. Every person is different so ask about the specifics of side effects, i.e. urination issues, use of Flomax to help relieve urination restrictions, bleeding and discharge from the anus, treatments you are restricted from because of a large prostate, what are the dr's PSA expectations after treatment, does he/she recommend spaceoar for treatment (separates the rectum from the prostate by 1/2 inch), to name a few.

There is a lot to ask but take one step and one day at a time. Keep coming back to this Mayo Connect site as there are lots of experiences and detail from real live patients. Use the search function to find more about treatments discussions. Get second and third opinions. Dr's are devoted but not infallible and cancer can be unforgiving.

Keep researching:
Nccn.org
Many doctors follow their guidelines, and it is there for doctors and patients
Decipherbio.com
Takes a slice of the biopsy which helps evaluate aggressiveness and modes of treatments
Viewray.com
MRI/Radiation machine combination unit
Mevian.com
Proton therapy radiation machine
PCRI.org
The Prostate Cancer Research Institute helps men and caregivers research their prostate cancer treatment options

Prostate Cancer Foundation (pcf.org) has a free Patient Guide- downloadable or hard copy which is a good start.
"Surviving Cancer " by Patrick Walsh, MD is an excellent resource, used and recommended by many.
Surgery/Radiation with or without ADT hormone therapy and AS (active surveillance) are the 3 treatment approaches.
Good luck with your consultation; your Urologist should provide more clarity to your situation.

Nearly every doctor you talk to outside a few will advise the most aggressive treatments possible, surgery (probably should be on the bottom of your list), all kinds of ADT with high amounts of radiation. Just be prepared for that and that you almost completely alone have to find out if AS, or something like Tulsa (multi-focal), or FLA (single easy focus only), proton without ADT, and so on can handle you. That means lots of travel and talking. Academic places are great but understand they have protocols, so sometimes if one is on the edge of a protocol they can dump you to higher treatments than you need too because whomever wrote the protocol put some limit without thinking - that may not happen that much but it can, these research protocols are written way before seeing patients so sometime it may not serve all the people good for something new or a new approach.

71 and in very good health is an excellent starting point for the long-term efforts of addressing and managing prostate cancer. Nice work! Presuming you have no co-morbidities, you are well-positioned to make an informed decision with lots of options. Sometimes having options makes it overwhelming to consider what to do, when you get overwhelmed, just sprinkle gratitude over all your feelings because not everyone has lots of options. + With a PSA of 7.7, I would be curious to learn more of your PSA history to get a sense of the doubling velocity and also to get a sense as to how long the GS7 has been manifesting in the prostate. + Hopefully at the ripe age of 71 you have retirement/financials/end-of-life plans that you are comfortable with, having this in place is the baseline foundation of your life situation, and that will be helpful as with each treatment options (curative first, palliative next) to understand how it impacts your plans. + Self-education is where you need to travel, likely it can get overwhelming, a good book about PCa is sometimes a nice resource to turn away from the computer and learn more. stay positive, you are in a good spot to make an informed decision.

It is my understanding that surgery and radiation are equally effective, however, if you have radiation and the cancer returns, then surgery is usually not available. Surgery preserves the option of radiation but not the other way around. Hence, I selected robotic RP and I think that I did the right thing. After my surgery my prostate was tested and my doctors upped the Gleason score to aggressive 9 which necessitate a year of ADT and Erleada. Under the circumstances, I though that this was a proper aggressive treatment for an aggressive, life threatening cancer. I tolerated the surgery and the meds well, the meds made me tired and I slept poorly, no desire for sex and had ED, lost lots of body hair and muscle. However, this was a serious cancer and I wanted the best chance to be around as long as possible. I was completely continent in 3 weeks post surgery. If I had to chose again I would make the same choice. Whether you decide radiation or surgery, it is far better than just observation and you should feel better once you decide and start the treatment. Be sure to select a top notch medical facility. Best of luck and best wishes to you .

Thanks for your response. It is really helpful. I received a number of other responses and I swear they are trolls spewing stupidity. I appreciate your honesty. Health and happiness!

Thanks for your response. Could you tell me what kind of surgery you had? It’s greatly appreciated. KJacko

I had robotic prostrate surgery at UCLA. My surgeon is a professor there at the university and well respected at the hospital. After the surgery about 10 members of his class visited me in the hospital waved at me and looked long and hard at my soft and tiny pecker. At 74 I had less modesty than at an earlier time and I was only a little shocked. For me the surgery and recovery were a breeze and post surgery meds were manageable. I am thankful to be alive and doing good. I take this cancer business very seriously and I am doing all that I can to staying alive as long as possible!

Did you have the prostate removed?

That guide has one inaccurate piece of information saying that proton treatments are experimental or at least their writing leads you to that conclusion. I wrote to them about this and never received an answer. I find so much bias against proton without a good reason for that bias.