SBRT vs. Robot-assisted radical prostatectomy

Posted by dandl48 Dave @dandl48, Jun 11, 2020

Well, my last visit to Mayo didn't go as well as I wanted. I'm 72 years old and I had an Ultrasound-guided transperineal prostate biopsy and the results came back positive for cancer with a Gleason score of 4-3=7 and the Grade Group of 3 which is a Risk Group of Intermediate Unfavorable. With these results active surveillance is out and it's either radiation or radical prostatectomy . If I choose radiation SBRT is available to me using protons for 5 treatments over a 10 day period. The downside of this treatment is I will have to have a 4 month Lupron injection before radiation and that if the cancer returns removal of the prostate would probably off the table. Choosing the radical prostatectomy which would be robot assisted, comes with its own problems, infection, incontinence and impotence. Decisions, decisions, I'm open for your input.

Thanks, Dave

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

web265 | @web265 | Dec 15, 2022

In reply to @whudup1 "After this Surgery, Do you have to urinate alot more. For instance traveling???" + (show)

I definitely did shortly after the surgery, say for the first 3 mos it was very annoying, then started getting better. I'm at about 15 mos now and just took a 6 hour car ride, stopped twice.

A few weeks ago I took a 4 hour motorcycle ride, my butt and fuel gave out before I had to stop to urinate.

vshirley | @vshirley | Nov 28, 2023

I had Eligard injection and now geting ready for 5 day radiation.Eligard has side effects such as hot sweats more urination at night etc.

Colleen Young, Connect Director | @colleenyoung | Dec 2, 2023

In reply to @vshirley "I had Eligard injection and now geting ready for 5 day radiation.Eligard has side effects such..." + (show)

Welcome, @vshirley. Are you getting proton beam radiation? How are you doing?

dgbauto | @dgbauto | Dec 3, 2023

Dave, I am 66 yrs old and have the exact same 4+3 =7 Unfavorable readings you have. PSA went back to 10 before starting new Eligard/ Rad regime. I also tried Hi-FU two and a half years ago, It did'nt work, took my PSA down from 14 to 8. More recent PET scan revealed cancer returned to treated areas and remained in missed or resilient areas. Now on Eligard 4 mth program with 28 radiation treatments beginning in a week or so. Eligard alone, PSA after 30 days is under 3. Testosterone level went from 409 to 2,5 Absolutely no libido, mild hot flashes are not too bad. Looking forward to TRU beam Rad machine getting rid of this....Hopefully

gently | @gently | Dec 3, 2023

Dave, in a similar position trying to decide, but definitely going for radiation. My only suggestion it to consider Orgovyx instead of Lupron. The only drawback also the advantage is that it is a pill so each day you'll be tempted to forget. But read about it because this is an inexperienced suggestion.
Proton 5 fraction looks like the best choice to me, but California Proton isn't presently offering the 5. And I wonder how the 5 fraction proton compares to 5 fraction photon. Especially since photon can be a MRI guided procedure. You must have researched Proton. How did you decide Proton vs Photon.
A second suggestion (ok I have two) is to have the Decipher genetic analysis of the tumor itself. It softened the blow of the biopsy results and may change your course. They use the biopsy material already drawn.
best wishes

dgbauto | @dgbauto | Dec 3, 2023

In reply to @gently "Dave, in a similar position trying to decide, but definitely going for radiation. My only suggestion..." + (show)

I wanted and preferred the Orgovyx pills, but Medicare wanted a $900 a mth co-pay. Pretty much left me with the covered Eligard shot. Dr. claims the T levels return faster after Org dosage is stopped.

gently | @gently | Dec 3, 2023

In reply to @dgbauto "I wanted and preferred the Orgovyx pills, but Medicare wanted a $900 a mth co-pay. Pretty..." + (show)

Did you check the orgovyx site for the co-pay cards? You may make too much money, but it is worth checking. I'm worried about the depression. This is depressing enough already.
Decipher will tell you if your tumor is resistant to anti-androgen treatment.
At least original Medicare pays for Proton. Where will you have the proton treatment?

dgbauto | @dgbauto | Dec 3, 2023

In reply to @gently "Did you check the orgovyx site for the co-pay cards? You may make too much money,..." + (show)

Local Hospital has the True Beam Rad machine, It seems to have multiple functions. Orgovyx web site only offered some potential discounts for commercial insured patients, not Medicare recipients.

michaelcharles | @michaelcharles | Dec 4, 2023

In reply to @dgbauto "I wanted and preferred the Orgovyx pills, but Medicare wanted a $900 a mth co-pay. Pretty..." + (show)

Orgovyx was covered under Tier 5 (25% copay) of my Part D Medicare drug plan, and I paid the out of pocket. However I transitioned to catastrophic coverage (the precise calculation continues to evade me) after 5/6 months and the out of pocket cost dropped significantly.
Eligard/Lupron, as injectables, are covered more comprehensively under Medicare Part B.