Where to draw the line between active surveillance, removal, radiation

robo45t: you will find many on this site who were happy with their decision whether it was removal or different types of radiation machines. For me, with a gleason 3+ 4, I chose a specific narrow margin photon radiation machine and spaceoar gel inserted to separate the rectum from the prostate. Out of the 5 radiation oncologists I spoke with, one offered active surveillance as an option. I learned early on that even with a Decipher genetic test to evaluate the aggressiveness and treatment mode of the cancer, that was only in the prostate, I did not want to take the chance that it would grow and go out of the prostate creating more problems and more treatments.

I was diagnosed last October and treated with 5 radiations sessions in January, finished in February. I wanted it done right away to avoid potential growth, the timeline of which does not seem to be predictable. I looked at all reasonable options including removal. I did not want to deal with the bag, incontinence or other removal issues including biological reoccurrence. The radiation machine I chose had margins of 2 mm instead of 3-5 mm so I felt I was getting some healthy tissue protection to limit side effects.

Its a tough decision but take one day at a time and get multiple doctors' opinions as doctors are dedicated but not infallible.

Hi Robo,
bens1, above pretty well sums it up. I'll add that even though you're at 3+3, if it were me I'd worry about the rather large size (and 4 positive cores) of the lesion. So assuming your PSA rose quickly, for myself I'd move quickly with the treatment of your choice. Added doctors' opinions are good, even necessary. Still, consider the PC's speed of growth and act before it takes a serious advance if appropriate.
Prayers, God Speed, and good luck.

You don't mention your age, or presence of any other medical issues. With this low-risk scenario, if I were in my 50s, I'd treat sooner rather than later, given there are several decades in which things might progress. OTOH, if I were in my late 70s on multiple medications, I'd keep watching, given the desire to have my remaining years free from cancer treatment side effects if possible. Whatever you decide, do it carefully, with several different expert MD opinions to help you think it through. And once committed, don't look back.

As to treatment path, it sounds like you'd rather avoid the risks and complications of surgery...

I m 64 almost 65. Pretty good health. Diagnosis in May/June. Talking to a surgeon this week and Radiation guy next week.
Thanks

robo45t: Sorry to hear about your diagnosis! Before making you final decision as to treatment I highly recommend reading Robert J. Marckini's essential book, You Can Beat Prostate Cancer (And You Don't Need Surgery to Do It). He is a huge advocate of Proton Beam Therapy, and given your situation of the cancer being contained to the prostate, I believe you are a prime candidate for this non-invasive therapy. That is my treatment of choice, which I'll begin late January of 2024. Good luck!

Big question is your age. Big difference in choices between a 50-year-old and a 75-year-old. At 73 I elected five proton radiation treatments at Mayo Phoenix.

robo45vt, you can see you area getting very good suggestions and guidance.

You are at the lowest on Gleason score. I don't think they list anything below 3+3=6. What I would do since is so low and you want more reasurances because of the biopsies is to asked for a Decipher test. It is a genetic test on the biopsies you have already had done so don't need to do them again.

It should give you an additional test to verify the biopsy results you got. My biopsies were rated as intermediate and Decipher came back low risk. So I was treated as low risk patient.

I see like other you did not list your age. I was diangosed at 75 and treated at age 76. I did not want a cancer in my body not being treated so active monitoring was never in my cart. I also did not want hormone treatments which was recommended at intermediate stage but not a low risk and my cancer per PSMA and bone scans was limited to being inside my prostrate.

Get second opinions, and consultations to help guide you. AND I would strongly suggest having the Decipher test regardless at this point. Then consider after getting second opinions getting PSMA (but you may find that with a 3+3=6 most won't recommend it).

Thanks. I ll look into it. I live in Vermont. Not sure if they offer the proton beam therapy here. Meeting radiation doctor on 12/29

Robo45vt, please follow this link (https://www.rrmc.org/services/cancer/treatment/radiation-therapy/what-to-expect/) to Rutland Radiation Medical Center to learn more about Proton Beam Therapy in your state. The final decision of how to treat your PC is yours to make, of course. An informed patient is the best patient…be an advocate for your own best healthcare decisions.

Robo, there is a lot of great advice previously mentioned. Given your relatively young age of 64 and being healthy, I would lean toward a more aggressive treatment plan. For me, active surveillance would off the table. When I was diagnosed with PC last September, I was praying the biopsy would come back 3/3. Fortunately, my prostate cancer was confined to the prostate (as far as any doctor can say), but Gleason Score was 4/3. I elected for surgery because I wanted the best chance for 30+ years of prostate cancer free life (obviously, no treatment will guarantee this outcome). Surgery allows for a complete biopsy of the prostate, seminal vesicles, and any lymph nodes that were removed. For myself, this was very important. I did not want to rely on imperfect imaging tools and biopsies to direct the treatment. Rather, I wanted to remove all known cancer from my body and have the margins physically defined. Also, given my age (56), I did not want to deal with the potential side effects of radiation and the inability/difficulty to perform a radical prostatectomy after radiation. For myself, the surgery was not that bad, with the worse part being the 1 week long catheter experience and the referred shoulder pain that lasted about a week. Outcome for me - Cancer confined to prostate, PSA undetectable 1 year out from surgery (praying this will continue for 30 more years). With surgery or any other treatment plan, you definitely want to go to a center of excellence - Your quality of life, for the rest of your life, will depend on the competence of the surgeon/oncologist/...

I agree with the other posts, don't let anyone tell you there is only one treatment plan. Every man and his situation is unique and you need to make the decision for your personal life expectations.

Best of luck with your decision.

Have a merry Christmas and a happy/healthy new year!!

Jim