Recently diagnosed: Treatment options for early stage prostate cancer?

Jdh697: I did feel lucky to have the Mridian. I cannot believe all those assets and service agreements are going to waste.

In any case, at least there are a couple of alternatives, Elekta with the Unity MR/Linac and the MagnetTx product, the Aurora-RT, that seem close to the Mridian although I haven’t checked into the details yet. They talk about tight margins but don’t identify what the numbers look like, though the built in MRI is a big deal.

I appreciate this information. I'd decided on Proton, you're expanding my vision. May I ask why you are still checking the details. Is there more radiation in your future

Gently: I hope for the best but plan, sort of, for the worst. I do not necessarily expect biological reoccurrence, but you just never know.

I also think it is helpful to some on this website to hear about the different radiation machines that are out there. Most of the comparison discussions on the Mayo website regarding Radiation are described as photon or Proton, focal therapy type treatments not withstanding.

Quite helpful for me. Wishing you the best luck.

Hello there,
I will offer my perspective and experience in this area and the questions you have regarding the hormone therapy etc. I’ve been on “TRT” for about 10+ years due to my HYPOGONADISM. I was doing great on my “TRT” and it was hugely
beneficial to my overall quality of life and wellbeing. I have been seriously debilitated from CHRONIC FATIGUE SYNDROME and FIBROMYALGIA for the past 32 years! Additionally, I was also diagnosed and treated for CHIARI MALFORMATION. Taken in its entirety, it’s been a “neurological tsunami” and changed my life dramatically from fully functional, athletic and able to participate and achieve almost any physical, mental, emotional goal presented while supporting myself spiritually as well.
When I was diagnosed with Prostate Cancer in August of 2022, I had to immediately stop my “TRT!” Of course, I certainly understood why and knew it was the initially, the appropriate medical option to incorporate. Personally, the “TRT” makes a huge difference in my quality of life. Discontinuing it brings my Total “T” levels down to between 20-100 which is extremely low. So, incorporating any kind of cancer treatment including medical castration or anything associated with that was totally out of the question for me. In one sense, it made my decision to utilize the “RARP,” or “RALP,” ROBOT ASSISTED RADICAL PROSTATECTOMY, ROBOT ASSISTED LAPAROSCOPY PROSTATECTOMY……..the best treatment choice for myself, (all things considered)!
Thankfully, my surgery was a great success. I encountered a few related complications which sometimes occurs and those were dealt with in a timely and successful manner. One of my greatest challenges was starting my rehabilitation process without continuing my “TRT.” Testosterone can feed the growth of cancer so you obviously do not want to be complicating your recovery with that obvious threat. I was severely dragging and extremely weak with barely enough energy to do a few minor chores each day and that was it. Finally, I was able to reinstitute my “TRT” 5 months following my surgery and within the first week I started to feel measurably better with my overall health, well-being, mood and emotional outlook! Personally, I’ve done a lot of research regarding the Androgen Reduction Therapy and there is very little evidence that supports its purported beneficial results Provasi’s in reducing the Biological Return of Cancer. In fact, the exact opposite has been found to be more accurate. Urology Oncologists are prescribing “TRT” to assist them with their overall recovery from Prostate Cancer Surgery and the entire rehabilitation process.
FACT: Every man needs to have a sufficient amount of Testosterone in his body to help maintain overall good health, well-being, muscle and bone mass and strength in addition to a healthier libido! I just don’t see the benefit of jeopardizing all of those important health considerations (on the chance), that LUPRON SHOTS or something similar will help to retard the growth of Prostate Cancer cells. Admittedly, there isn’t any hard fact proof that it actually even achieves it. Of course, it sounds logical and for some patients it might even provide some beneficial results. However, the significant amount of new, current and updated medical research and studies just do not support it as a viable treatment option. Thankfully, in my case, it was never going to be so amongst other important treatment considerations used to arrive at my surgical decision etc. Androgen Reduction Therapy was never going to be a viable choice for me.
I am happy to report that since my very first PSA result taken the day of my surgery, 10/25/22, was < 0.014 (undetectable), and has remained at that level through today is very encouraging. Of course, I don’t assume or take anything for granted and get my PSA level checked every month or sometimes miss one month in between but remain very serious about the frequency of the tests and maintaining a very “active surveillance!”
As you know, there is NO best treatment for any Prostate Cancer Patient. There is only the choice and decision of what you believe is the best treatment option for yourself, recovery, rehabilitation and possible options for additional treatment in the future if required. for you and your loved ones.
As I coined the following phrase early on in my treatment phase, (please feel free to use it).

CANCER: is DUBIOUS at best, SINISTER at its worst and VILLAINOUS the rest of the time.

You are either in REMISSION or you are not!
I pray every day that I remain in remission at at age 69 and beyond until the day I pass away from some other, unrelated cause.
Sending all of my fellow patients the best of luck and well wishes for “Continued Remission” and the best of everything.
GODSPEED

Glad everything is working out for you. I went back on my TRT on October 1. I gave my Radiation Oncologist 8 months off of the T. He wanted a 6-month Lupron shot and 2 years with no testosterone. At my age of 73 now 74 the studies show that the testosterone suppression really didn't help with BCF or Overall survival because of my age. Just hedged my bets. I go back on 1/17/24 for another PSA test and hopefully it stays at undetectable like the first one at 3 months.

jc76, you wrote, “ I had 30 rounds of proton pencil radiation and finished in July 2023.”
Did you consider SBRT (stereotactic body radiation therapy)? Rather than 30 rounds of treatments, it typically involves only five treatments over 1.5 weeks and you’re done.
I would appreciate reading any comments you might have on this from your experience and/or your research. Thanks for all your good postings on Mayo Connect, by the way... 😊

jamesharrison, I was originally diagnosed at Mayo Jacksonville. They offered only Photon radiation. I wanted to go with proton after research and my Mayo PCP briefing me on UFHPTI proton therapy and pros/cons of both.

The research I did included Mayo (Rochester and Phoenix offer proton), Web MD, American Cancer Society, Hopkins, Cleveland Clinic, UFHPTI, a specific prostrate cancer web site, and several other medical institutions. I did not know about MCC back them. All cited that proton releases very little radiation on body going in, AND biggest difference does NOT exit through the body like photon but stops at prostrate. Thus should reduce the amount of radiation damage to surrounding organs and tissues. The research on this is limited though and many institutions are doing long term research and UFFPTI received a 25 million dollar grant to do long term research on proton and photon.

There are new photon treatments out there (which is what Mayo Jacksonville uses) that can fine tune the radiation and different angles to radiate prostrate to limit damage to surrounding organs and tissue but again that radiation type passes through the body.

I have a ICD/Pacemaker and not sure this had to do with with high dose not offered. I was not offered the 5 high dose radiation treatment you mentioned by either Mayo or UFHPTI. I would have opted to do that if offered.

I since have learned about the 5 dose by being on MCC. I was not aware of MCC back in January/February. After I finished treatments and was learning about seminars at Mayo Jacksonville Mayo provided the link to MCC. It is then I found out about the 5 dose high radiation treatment you are talking about.

I posted under "would you do anything different" that I would have done the 5 dose treatment if I had qualified for it. Having to do the 30 dose over 6 weeks was very time consuming and thus very stressful. I think it would have really help with anxiety and the stress of 30 rounds of radiation, 5 days a week for 6 weeks that I got versus only 5 over two weeks.

My Mayo PCP and I went over AFTER I had treatments the proton and photon radiation treatments so I could know exactly what the difference was. He used a computer program to show me. I wish this had been done by the original Mayo oncologist/radiologist. UFHPTI did show this computer program information to me also but was after treatments finished as I had question on whether they treated just the cancer areas or entire prostrate. My radiologist/oncologist at UFHPTI treated the entire prostrate to ensure they don't miss any cancer area that biopsies and MRI could have missed.

My PCP did mentioned to me that the research was showing higher side affects with the high does 5 treatments over the lower dose ones like I had. But he said this would be expected when using high dose versus low dose. The long term research on this is not out on this so is only preliminary information and not conclusive.

My Mayo PCP is outstanding. He said during his medical school he did research at UFHPTI and thus learned a lot about proton radiation. FYI: UFHPTI has been treating patients with proton radiation since 2006 and has treated over 11,000 patients from 34 countries and all but 2 states.

My PCP briefs his patients about both proton and photon and lets you decide. He recommended I get two consultations and treatment opinions from oncologist/radiologist before deciding which I did.

I am sorry for such long posts but I sure wish I had known about MCC back in January/February when trying to decide on treatments so glad to help if I can. I could have asked about the 5 dose treatments and more questions that I have learned from MCC that I could have used during my consultations.

Good morning Jim. My circumstances are similar to yours. I have surgery scheduled in 2 weeks at Mayo with Dr. Tollefson. I am still not totally comfortable with this decision. What made you finally decide to on this option rather than radiation ?

@softail2000, you might find this discussion helpful:
- Radiation for Prostate Cancer with Ulcerative Colitis
https://connect.mayoclinic.org/discussion/radiation-for-prostate-cancer-with-ulcerative-colitis/