3rd opinion: How many opinions did you get for prostate cancer?
My husband was recently diagnosed with prostate cancer. I think maybe stage four but I’m not sure. He has a 3+4 Gleason score 13 PSA he’s 54. He has of also rheumatoid arthritis and thyroid problems. His initial urologist recommended surgery he then sent us to a specialist who also recommended surgery because of his age and relative good health. I follow a Facebook group on this subject, and Majority of them recommend another opinion, so I don’t know I’m just curious what everyone else thinks. I’m told that because the guy we saw today was a surgeon that he would naturally recommend surgery which is kind of what my husband thinks but he said today that if my husband was to have radiation first and then down the line , come up with cancer again that he wouldn’t be able to do surgery so I don’t know we’ve got surgery scheduled but I’m just curious if anyone else has been through this particular scenario what your thoughts are etc. thank you
Interested in more discussions like this? Go to the Prostate Cancer Support Group.
I'm 62, in reasonably good health, and had a Gleason of 3+3 (after surgery revised to 3+4). Because the Decipher (genomics) test was so bad, I had to do something. I opted for robotic surgery. No regrets.
Pain was minimal. One night in the hospital. Once I left the operating room, I never took opioids. After a two days at home I simply forgot to take Tylenol, and then never restarted.
I was able to work part time from home after a week, and after two weeks full time from home. I could have easily gone into my office, but worked from home for four more weeks. Incontinence was minimal and got better rapidly. (I'd started kegels before surgery.) Now three months from surgery, I have no incontinence at all and no longer wear pads. Sexual function is slowly returning. Cialis helps.
I chose surgery because if radiation doesn't get it, surgery after radiation is so difficult. I also didn't want to take the hormone suppressors so often prescribed with radiation.
Surgery for me wasn't life changing, except I do hope sexual function keeps gradually getting better, which my surgeon assures me it will.
My case is very similar to the previous post. At age 58 I was diagnosed with PC and a 4 +3 Gleason score of 7. My urologist termed mine "intermediate risk" cancer as there was no sign of spread at the time. I too was faced with the surgery first or the radiation first decision and chose surgery. I wanted that "Sh@t" out of me as soon as I could. Surgery was in September of 2016 and I was clean for 5 years. Now it has slowly creeped back and I'm on to the next phase of treatment…..ADT and radiation.
For perspective, post op for me involved very little pain meds, if any, and incontinence was gone by the third month. I had one hiccup after surgery that caused me to have to wear a catheter for 7 weeks because I did not heal as fast as expected. Apparently there was a leak in my urethra. Sexual function is there and works but it is not the same as pre op. Nonetheless, the tradeoff for me was worth it and I had 5 cancer free years. Now that it has come back it is in a much more diminished stage and I am mentally stronger to deal with it.
I had RALP last year at age 60. No issues with incontinence. Gleason 4 + 3 and PSA at 3.46. Really no pain to speak of. 8 days with catheter after surgery. My surgeon made me speak to an Oncologist about Radiation option before he approved surgery. If you do surgery make sure he has several hundred operations under him using the Robotic system. Good luck with your decisions.
Gleason 8, with seminal invasion. Both surgeons we met with recommended ADT and radiation over surgery. Both said chances of recurrence were equal between the 2 treatment strategies. We went with the radiation.
I had an easy surgery, Gleason 9, seminal vesicles invasion, 75 years old. I was told by UCLA surgeon that surgery is the gold standard and it facilitates radiation treatment later and I was most concerned with the later issues. I think that I made the right choice
I feel compelled to respond to you on this. I also was diagnosed at 65 with stage 4, Gleason of 4+3. I went for a second opinion to one of the few National cancer centers in our region. The oncologist/surgeon felt that surgery was my best option. I had previously seen a Urologist in our home town that strongly recommended not having surgery due to the risk that the cancer had spread to other areas in the body. At the National cancer center just prior to our leaving they asked if I would be interested in a fairly new scan called the psma scan with an isotope to be sure their was no other signs of cancer in the body. ( new scan FDA approved in July 2021) I agreed and once the results came back it was determined that the cancer had spread to my L2 vertebrae. If I had had the surgery as suggested I would not have been able to target this new found tumor on my spine. The decision was made then to have 3 high doses of radiation therapy to the L2 and 28 doses to the 6 tumors on the prostate along with Lupron ADT. I only tolerated the first dose of Lupron and completed the full course of radiation. Today I feel great and my second 6 month psa was 0.11. I just feel that if i had settled with the opinion of the second opinion (surgeon) I wouldnt be where I am today as far as my treatment. Hope the information is helpful!
I think that most cancer surgeons would recommend radiation if there was evidence of distant spread of the cancer. It sounds like you made a wise decision. My cancer had spread locally to the seminal vesicles, Gleason 9, The committee of my doctors at UCLA all passed on my surgeons recommendation of surgery. Glad that you are doing well and we all hope that this continues.
saralie67: I had 3+4, 10.2 psa and am almost 70. I looked at both options, targeted radiation and prostate removal. As you suspected, I too believe as you that there is a natural bias by dr's to go with what they have had success with but not necessarily with what is right for your husband, specifically quality of life via side effects. I did not want to risk side the effects of the prostate removal and was willing to take the risk that I could find a surgeon skilled enough to deal with prostate removal after radiation, later on. I also decided on the Mridian radiation machine by Viewray for a number of reasons including more effective targeting/tighter margins (2 mm).
I was also hearing on this web site mixed reviews of prostate removal, some with REALLY good results and some not so much, in terms of side effects. I was also surprised how many people had their prostate removed but then re-occurrence happened later on. I would make the decision I made again.
My wife has 3 kinds of arthritis including, rheumatoid. As you know from your husband, pain is a challenge everyday. IF the side effects occur after prostate removal, they may include pain for a while on top of what he already has. My side effects for the Mrdian radiation were minimal (reduced urine flow) and controlled by Flomax.
You might want to get an opinion of a radiation oncologist outside your current husbands surgeons institution. It sounds as if there are some unanswered questions for you, rightly so, that still need to be answered. Best of luck and keep asking questions.
In a half dozen responses, you have received a "million dollars" of input. All extremely accurate and focused.
Surgery vs Radiation + ADT.
Note: A PSMA PET scan could identify whether or not there are distant metastases.
If not, then RP might be as close to a "cure" as one can get.
If yes, then Radiation +ADT might be preferred to "carpet bomb" the spread cancer.
There also is a school of thought that if a discreet Metastatic tumor is located by pet scan, surgery can be performed together with radiation targeting the tumor outside the prostate.
And yes, the choices are both simple and complex. And evolving rapidly.
No single answer. Sorry.
How does your H feel about the different side effect risks?
As my Dad used to say "you pay your money (meaning make your choice) and take your chances".
We are truly fortunate to have good choices for treatment.
72 yrs old at RP Aug 2022.
My preop PSMA PET scan was inconclusive/did not identify distant metastasis.
Gleason 9 with EPE at RP. Gleason score anticipated; EPE discovery very large disappointment.
Excellent surgeon and surgical result.
However, failed 1st 90 day postop PSA at 0.19.
Now halfway thru 37 txs radiation together with 4 mos ADT (Orgovyx).
Zero regrets; I thought that the upside of prostatectomy was an opportunity that I wanted to take.
And my postop surgical recovery has met or exceeded expectations.
A percentage (25% or so?) of RPs "fail" postop.
With tx ongoing, PSA has been driven down to
(My response was cut off)