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Overtreatment of Prostate Cancer
Urologists are trained to do invasive treatment, such as prostatectomy, for many levels and types of prostate cancer. There may be a tendency to overtreat since treatment is what they’ve learned and likely constitutes the greater part of their prostate cancer practice. I’m 74 and a nodule was found by my urologist through a digital rectal exam (DRE). He set up both a CT scan and MRI (both covered by insurance - Medicare Advantage - in my case). The MRI reading came back suspicious for the nodule and found one other small lesion that was suspicious. I then had a transrectal ultrasound biopsy which showed cancer in two of 14 cores taken. The small one was Gleason 3+3 and the larger one was 3+4. That put me in the staging group of intermediate favorable. My urologist then had my biopsy tissue sent for a genetic/genomic test by , which was also covered by my insurance). It came back indicating I was in the active surveillance (AS) category, although at the high end. My urologist and I agreed to go the AS route with appropriate PSA testing and likely biopsies going forward. If progression is found, I can then opt for appropriate treatment before any metastasis can take place. And newer, more effective treatments may then be available. My point, and it is only that of an informed layperson, is that Gleason cancer scores of 3+4 are not necessarily an indication for treatment. However, the younger you are, the more likely that 3+4 may require treatment. Always review your particular situation with a trusted urologist. But different urologists can have differing viewpoints on treatment, so second opinions are often appropriate. Excellent YouTube videos on many aspects of prostate cancer are by Mark Scholz MD and Michael Ahdoot MD.
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If you're running for the bathroom a lot, Mirabegron (Myrbetriq) can be helpful — it relaxes the detrusor muscle that involuntarily squeezes your bladder. I had to go up to 8 mg/day, and it takes a few weeks to kick in.
Prior to selecting my surgeon, my urologist told me to feel completely comfortable with my surgeon; besides experience that should be the determining factor. I am completely happy with my choice. Other than constipation, never had any other side effects. Next week I get my first PSA follow up. Praying for the best. I asked my surgeon about an oncologist if needed, and he said he works with one very closely. Hopefully I don’t need him, but if I do, I’m confident in my surgeons choice. The bottom line is: I am pretty much following the same path as you. Good luck!👍🙏🏻🤞
toolbelt, who is your "urethra sparing" RO.
I would like to know uretha sparing RO also
I know this is a "Mayo" forum, but even if we are not treated at Mayo we can all learn, share, and help and be helped. Jason Call, MD in Las Cruces NM. Mayo trained. Excellent, compassionate doc who is doing cutting edge treatment.
"Google" urethral steering. I am sure there are a number of docs doing it.
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4 ReactionsThank you so very much.
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1 ReactionPSA of 40 sent me to a university hospital near me. No outward systems except frequent urination. DRE suggested biopsy. Biopsy showed (2) 3+4 and (1) 4+3, Gleason 7.
Subsequent MRIs, Pet Scans, Bone Imaging and a PSMA Pet scan showed no travel/uptake in any near organs, bones, or tissues.
Doesn't that make me a LOCALIZED Prostate cancer patient?
7/26/23 I began ADT (Abiraterone and prednisone) and Luprolide. 8/30/24 PSA was 1.92.
9/30 PSA was 0.11,
28 days of IGRT lowered my PSA to 0.01 at conclusion of RT, on 11/30.
Doctors want me to continue and ADT and Luprolide for two years.
Does this make sense to anyone? They are treating me as if I have Advanced Metastatic Cancer. the treatment is terrible and I want out as soon as possible.
Thoughts, please, as I have an appointment on 2/1 for my THIRD $17,000 shot of Luprolide Depot.
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1 ReactionForgot to mention: 72 year old male in otherwise excellent health.
And it is SYMPTOMS..not systems...
Medicare Advantage covering almost all costs, too
You may want to ask your urologist to have a genomic/genetic test run soon on your biopsy tissue. I used Prolaris. Results will give a suggestion for treatment for your particular case. I had a favorable Gleason 3+4 score and Prolaris came back with a suggestion/recommendation for active surveillance, although I was at the high end of the range for surveillance. I am on surveillance now. My Medicare Advantage coverage covered the cost of the test.
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2 ReactionsWell, I am not an oncologist, but I am a patient looking at biochemical relapse after surgery 4 years out. I know I will need about 40 treatments buy they haven't told me yet about how long the duration of hormones would be. From what I've heard, they are NOT fun nor are they good for you, but they do tamp down the disease.
However, it DOES seem like a long time to be on hormones in your case. I could see continuing for maybe 3-6 months after radiation, but more than that?? It seems like overkill to me at this point and I would definitely get a second - and even a third - opinion. There is no "one size fits all" for this disease so you may have other factors that are being considered. If two other oncologist agree with your first one, well that's pretty much it. But I really think you will get a wide diversion of opinions here. Best of luck and please let us all know what you decide.
AL
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