Prostate cancer treatment options?

Before surgery they advised that I probably had Gleason 8 and I was given lupron and Erleada for 6 months and then surgery. After they removed the prostrate and examined it they determined that it was Gleason 9 and they continued with 6 more months of these meds

For myself (56 when diagnosed last year, GS=4/3, healthy, active), addressing the prostate cancer with the most aggressive procedure (robotic RP) was the right decision. I did not want to take any chances with radiation/hormone therapy, wanted the prostate removed & full pathology to be performed, and wanted to leave as many options open if the PC returns. As others have mentioned, please do your research and pick a center of excellence.

Best of luck with your decision,

Jim

I don’t know what the heck you are talking about. You have sent me a half dozen stupid responses that have nothing to do with my question. How dare you use this health site to spew your BS. Stop the crap and get lost.

I just turned 74 and like you have an enlarged prostate 120 grams. I have been treated at Mayo in Phoenix. My PSA was 2.9 My MRI showed a 7mm lesion that was not palpable, and my 30-core transperineally MRI fusion guided biopsy showed two cores of 4-3 and two of 3-4 all from the same area. The rest of the prostate was normal. I was classified as unfavorable intermediate risk prostate cancer because of the 4-3. I elected the five SBRT proton radiation sessions that are on a Monday, Wednesday, Friday, Monday and Wednesday. I had the SpaceOar Gel inserted when the markers were put in to protect my rectum from any stray radiation. The sessions were a piece of cake if you don't mind having a 100 cc saline filled balloon up your butt to immobilize your prostate and can hold a bottle of water in your bladder to move it out of the way too. My side effects are none and I even messaged my radiation oncologist to see if they gave me the correct dose of radiation. My three-month PSA was undetectable, so I am thrilled with the treatment I chose. The only problem I had was after the second radiation treatment and that was my fault. They tell you to avoid caffeine and I had my insulated mug of coffee waiting for me in the car after the first treatment and drank it on the drive home and finished the pot when I got there. I did the same routine after the second session and after about an hour after I finished off the pot my bladder said, "You dummy you should have listened". I had to pee about every 15 minutes the rest of the day. Needless to say, I laid off the coffee for two weeks after my last session. Since you are over 70 with favorable intermediate risk prostate cancer you will want to read "Radiotherapy with or without androgen deprivation therapy on intermediate risk prostate cancer" it is in Radiation Oncology and shows there is no advantage to getting a Lupron shot at our age. Another study is "The need for androgen deprivation therapy in patient with intermediate-risk prostate cancer treated with dose escalated external beam radiation therapy." There are other treatments you should look at like CyberKnife, MRI guided radiation in real time. I had a CyberKnife near me, but he wanted to pump me full of drugs and did not do SpaceOar Gel. The MRI guide radiation is only done in a few facoilities none of which were near me.

Thanks for the response. A number of men who responded favored proton therapy. I’m gathering as much info as I can when I plan to hear from my doctor.
Health and happiness!

I am always happy no matter what. It is a choice. People say their glass is half full but mine is always full because I OWN THE GLASS. Oh, and about that large prostate, I see to be flowing better now after the radiation than I did before. Do read those articles and Google Proton radiation and prostate cancer as there are a lot of studies out there.

👍🙏

I was pretty much in the same boat. 70, 3+4. Though my MRI showed five lesions, including a PI-RADS 5, and my second MRI showed substantial growth. After some research, I was leaning toward HDR brachytherapy. Without any prompting my Mayo doctor recommended that option. I wanted to avoid the robotic surgery down time, ten days with a cath, and the higher risk of ED and incontinence. Radiation also has risks but HDR seemed to have the least (no moving seeds as with LDR brachytherapy, and no radiation exposure to healthy tissue from external beam; although the CyberKnife external beam promises very little exposure (only some on the way in). HDR is the second most invasive (after surgery) in that it requires two out-patient procedures, both long days. I had no pain or problems. My HDR was last April. I do still have a weaker stream, which can be a risk with radiation because it "cooks" the prostate and can cause a bit of swelling. Your options are cut, burn or poison (chemo). You will find there is no great option, only accepting some reduction in quality of life to increase your chance of living much longer. There are some great things reportedly coming (a pill that triggers your immune system to wipe out the cancer) but those things are likely beyond your ability to wait them out. Good luck.

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Thank you!