Recently Diagnosed, Intermediate Prostate Cancer

Highly recommend decipher test . I was confident in my decision for surgery but decipher test just confirmed decision for me. I was high risk 93%. Was diagnosed 3+3 but after surgery dissection of prostate was 3+4. 59 years old 6 months post surgery doing good. Still have so dribble not to bad . Ed work in progress. Using Trimix injection is a great option for me. I had enlarged prostate also just don’t remember size. Ed was a problem before surgery along with peeing all the time. Something to consider in surgery vs other treatments. Wishing you the best and a peaceful decision.

I choose surgery because, as mentioned by others above, I felt it gave me greater flexibility with salvage radiation if needed (I was diagnosed at age 51 with Gleeson of 4+3=7). Having two reoccurrences since surgery in late 2017, I believe I made the right choice. Unfortunately, PC often does come back, so having as many tools as possible is important.

A regret was not going to one of the best medical facilities after my first reoccurrence and before blindly radiating the prostate bed. I chose to use my local urologist. I now see Dr. Kwon. If I had used Dr. Kwon beforehand, he would have likely done a PET scan to see the specific location before starting treatment. In my experience, the Mayo's of the world have much greater access to current research and treatment options.

I hope this helps and I wish you the very best of luck!

Good morning. Sorry you got the diagnosis but, as you can see, you have a lot of company.

I was diagnosed 2 years ago at age 68 with Gleason 8. No evidence of spread on scans and the MRI suggested it was confined to the prostate. In excellent health otherwise. I talked with numerous colleagues of mine and sought opinions from Urologists and Radiation Oncologists. There was no "right" answer regarding surgery vs radiation (I realize there a several additional options available but I did not consider them). As has been mentioned, RP (surgery) immediately removes the cancer, allows more complete staging and lymph node sampling and reserves the option of salvage radiation therapy in the future should you need it. Surgery after radiation is fraught with difficulties. Unfortunately, 6 months later a single metastasis was discovered in my T8 vertebral body and I once again did my homework and elected aggressive treatment at Johns Hopkins. A year later and my PSA is undetectable and I am off all medication/treatments. Fingers crossed.

Side effects with surgery are immediate-incontinence (significant majority temporary), rarely infection or other risks of surgery and ED. The side effects from radiation tend to be delayed-possible incontinence and ED but also bladder and bowel issues should they be in the treatment field. Increased risk of other cancer is a questionable and very low risk and tends to be decades later.

Although your biopsy shows a Gleason 7 it only samples a very small portion of the gland. If you have surgery it could be upgraded or downgraded.

The choice of treatment is difficult and depends on individual and personal factors. There is no one size fits all. Educate yourself and discuss with doctors you trust and are willing to give them time to you. Avoid listening to individuals who claim there is only this way or they had such and such a complication. They are a single person and may have an ax to grind. Large scientific studies tend to give the best information regarding outcomes and side effects.

Good luck.

Had mri last week am scheduled for 5 day sbrt next week.My oncologist says they are doing the planning from ctscan and mri results.Did you have cat scan and markers inserted in prostate? Psa was 12.5 in June had eligard injection in July and last month psa 7.5. I have spaceoar also. Was your procedure mri guided?Facility here does not have that capability.

Vshirley: my procedure had a built in MRI so they were seeing my prostate in real time while they did the procedure. When they use fused images they increase the margins to make up for the fused image real-time trade off.

Although my markers were not required, since my RO was putting the spaceoar in anyway, she put markers in as a backup in case there was a maintenance issue with the machine but all went well and I did not mind that as it struck me as being on the cautious side.

They did a ct scan and an mri on the machine, pre-treatment, for initial mapping and then final mapping in real time.

Glad you are only doing 5 treatments. You might want to have your radiation oncologist prescribe Flomax to you ahead of time so that you have it available immediately if you need it. For me, after the third hypo-fractional treatment, I needed it and got relief overnight regarding urine flow, but was never in any pain.

Good luck next week.

Thank you so very much for the info and Good wishes.Did you lose weight during or after treatments and where did you have treatment as I have not been able to find facility with MRI guided procedure.My oncologits assures me all will be fine the way they are planning it.

I did not lose weight or gain weight after the treatments. My weight has always been managed reasonably over the years and I have stayed active.

Here is a link to Elekta’s treatment centers:
https://www.elekta.com/patients/treatment-centers/
You have done the spaceoar which should help and they will ask you to drink water each time about 45 minutes before your treatment to help separate your bladder from the radiation. You may under or over do that but they will let you know. If you believe that your doctor has the expertise to accurately map your treatment plan then given all the prep work you have done, you should feel good that you have taken steps to minimize side effects. Keep asking questions of your doctor and the people (physicist, dosimitrist…) that are in the treatment room with you. It’s scary but after you have had your first treatment, you will feel more comfortable.

Sorry vshirley, to answer your treatment location question, I had my treatment in Orlando Florida through Orlando health, after speaking with 5 radiation oncologists at 3 centers of excellence, all of whom I knew had the MRIdian machine. My RO trained at MD Andersen.

Thanks for taking the time to reply. I know what you are saying about surgery, its out and if there is a recurrence the radiation is the follow up. I just haven't been able to make a decision at the moment. As I mentioned I have no scans as of now. Working to get those at an out of area facility. I'm in a rural area and any kind of advanced care or treatment is 100 plus miles away and booked weeks out. I'm not getting rushed by these Drs. One told me I needed to make a decision on treatment and get started no later than six months from my diagnosis, Nov 1st. Then on a later visit same Dr. insisted that I make a decision and get scheduled in the next 2-3 weeks. Urologist , surgery I suppose.

Scj. I understand your situation. I live about 75 miles north of UCLA where I had my surgery and my numerous 3 month follow up appoints ( every 3 months for the last 2 years). All of the travel is inconvenient, but it is a life threatening disease that gets worse without treatment. It is very important that your cancer is aggressively addressed before it spreads out of the prostrate area. Good luck