47 years old with newly diagnosed Gleason 7 (4+3)
I was recently diagnosed with a Gleason 7 (4+3) after my PSA jumped from the 4's for several years into the 6.4-6.6 range in the past 6 months. My father also had Prostate cancer. Both urologists and the radiation oncologist (that works for one of the urologists) said that because of my age that surgery was the only (or at least best) option. I'm in Colorado where there are no proton beam therapy centers, but this really seems like it could be a better option than surgery to have a better chance of a higher quality of life. Am I just dealing with doctors that are biased towards the familiar and traditional practice of radical prostatectomy, or does my age really mean that surgery has a much higher success rate?
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Sounds like you need another opinion, if for no other reason to know your options. Since you live in Colorado I would suggest a virtual visit with Mayo. They will request all of your records prior to your visit. I have had virtual visits with a Mayo urologist followed by a virtual visit with a radiation oncologist and will have high dose brachytherapy in Rochester next month. I had the option of the high dose or proton therapy but chose the high dose due to reduced travel and a past history of radiation treatment. Considering your age and family history you may feel more confident with going to a Center of Excellence for prostate cancer.
I'm 62 and started my journey with a large multi-state urology group who found 3+4 in March. I received recommendations from them, but also obtained a second opinion on my pathology from a nationally recognized expert and received a second opinion from my local institution in Baltimore that is a center of excellence (COEs are self-designated, but indicates an institutional level of commitment), member of NCCN, and a NCI cancer center. Mayo also checks all 3 of those boxes. Centers such as those will nearly guarantee you receive recommendations based on the most current understanding of the literature, but also backed by a wealth of experience. Focus on centers that check at least 2 of those boxes, if not all 3.
Especially if you have kids, you may want to enroll in the free Promise Study https://www.prostatecancerpromise.org/ that will determine if you have genetic mutations associated with prostate cancer.
There are treatment options (brachy + SBRT for example) that compare extremely favorably with surgery in terms of success/cure, BUT you will need to weight that with your preferences and risk tolerance for side effects and what happens if you have a recurrence. All the more reason to obtain that second opinion from a trusted source.
I was 73 when I had the same Gleason (4+3) and my PSA was jumping up – went up a point in 6 months – was at 6.5 when I had the biopsy.
Radiation was recommended because of my age – they said that the radiation could cause another type of cancer in 20 years with the implication that I likely would die of something else anyway by then.
I had the radiation – 39 treatments – and it looks good so far – 1.5 years later. 39 radiation treatments over 8 weeks is pretty tough – I hated it. I now have ED as a side effect of the radiation.
Make sure you get the best possible surgeon possible if you go the route recommended. As I understand it the prostate is surrounded by nerves that if cut can give you ED. But as I said before the same thing can happen with radiation.
The other thing I did, after radiation, was read the book by Dr Greger, How Not to Die. Changed my life as it put me on a path to good health. The book itself pushes becoming vegan, but as a result of it I became interested in the latest science on health and found a series of podcasts at Hubermanlab.com (a research scientist at Stanford). Regardless of the direction you go, boosting your immune system will help your body fight cancer. I rushed into the radiation and in hindsight probably should have spent a little time reading first. Greger's book has a chapter on prostate cancer related to diet – it is the same stuff you will see, for example, in Kaiser (health care) in a more concise form without the studies behind it listed. You might take a look.
Get a second opinion. And a copy of the book surviving prostate cancer by Walsh, it will help. Also have your cancer tested to see how aggressive it is, it will help in treatment. I just finished high dose radiation/hormone therapy on Friday. I saw a surgeon first and he ruled out surgery. I know it’s hard and confusing but get the book and read it. Also go on YouTube and watch the many videos on this. Especially from the PCRI, Prostate cancer research institute. I know it seems insurmountable but go slow and do your research.
DEFINITELY need a second opinion from a Proton Treatment center! The non-Proton people say that the results are no better than Proton Therapy, but the data is still young, and in my humble opinion I don't think the lasting side effects are counted very accurately. Plenty of data about survival rates and such. Lots of guy just "want the cancer out" and I understand that.
My son's girlfriend's Dad had a Prostatectomy 8 or so years ago. He still wears diapers and pullups all the time. Another friend that had Robotic Prostatectomy 2 years ago – had a pretty good result, but still has to wear a pad in his underwear.
Good luck on your journey.
And welcome to the club none of us wanted to belong to !
I am 74 and had 4-3 in two cores and did 5 proton sessions at Mayo Phoenix. My PSA was between 2.4 and 2.9 for the last 5 years. The first doctor they sent me to after the biopsy was a surgeon and after I said no way he dropped me like a hot rock and showed me where to schedule a radiation oncologist. I am much older than you and if this kicks the prostate cancer can down the road 10 or 15 years, I am now 84 to 90 years old and much more likely to die of something else. Since you are in Colorado you are not far from Mayo in Phoenix and since prostate cancer is so slow growing you could schedule your radiation treatments during the Arizona Fall League Baseball season. The weather is great here and the rooms are way cheaper than for Spring Training. The Rockies and Diamondbacks facility at Talking Stick is one of the teams that host the games and is within a couple of miles of Mayo. There is an extended stay hotel adjacent to the Mayo Clinic and some of the patients I met were staying there. Just a suggestion if you do radiation. Definitely get a 2nd opinion. Good luck.
It seems too me that their are pros and cons to everything you could do. Get more opinions, is what I would do. There is so much out there. It boggles the mind. Be sure to ask what is the statistical probability of a favorable outcome, risks vs returns..etc. How much time do you have to make a choice. ADT could give you a lot more time. I'm 8 months into it. and PC is undetectable.
I was diagnosed at 73, with PSA on 19.8, and some 3+4 and 4+3s.
I had a PSMA test that showed my cancer was contained to my prostate and had not spread. Great news.
Yes, get the Walsh book, read all the highlights at the chapter beginnings. Read further where it interests you.
I researched articles from Mayo, John’s Hopkins, Cleveland Clinic, M D Anderson and others and gathered many into a notebook, as well as one large Word file.
I had discussions with a Radiation Oncologist and a Surgeon, even discussing that, at 73, ED has pretty much set in.
I even recorded, with permission, my doctor visits, transcribed them and re-read as necessary.
I had one long session with my Urologist covering all me readings and thoughts. He stated that, in case of a recurrence down the line, radiation after surgery is more effective than radiation first and surgery later.
I finally said that I was feeling that RALP was me préférence. He said that if these numbers were his, he would make the same decision.
The Urologist had me do several weeks of Pelvic Floor PT prior to the surgery; all margins and lymph nodes were clear. We joke about my being medically “unremarkable and boring.”
When the catheter was removed, I resumed the PT for a few more weeks.
Due to all the PT, I was fully continent immediately after the surgery. I did use diapers and pads just in case, but there were no dribbles or spotting.
My surgeon did the nerve sparing surgery that was developed by Dr Walsh. I am on 20mg of Tadalafil nightly to help reestablish blood flow; I use 100 mg Sildenafil and a vacuum pump to “exercise the soldier.” I’ve even been able to “exercise“ without the Sildenafil!
Whatever choices you make, I wish you the best of luck!
Covodoo: Great information from others in this string.
In answer to your initial question, doctors tend to choose for you that which they have had the most success with less regard towards other choices that may be better for you and quality of life. Most talk about outcomes and talk less about quality of life.
I am 70 and experienced that after speaking with 6 RO’s, 1 urologist and an RP specialist and a bunch of patients treated in different ways.
If you work remotely, and are considering radiation and can travel, you might want to consider the Mridian linac machine from Viewray (Viewray.com).With Radiation, avoiding exposure to healthy tissue is important. It uses 2 mm margins instead of 4 to 6 mm margins for other Radiation machines. It is the only machine in existence that has both a built-in MRI and radiation so that everything is in real time. I also used Spaceoar. I finished my five treatments in February. I took the decipher genetic test to test aggressiveness.
One step at a time and keep coming back to Mayo Connect. Good luck.
Most everyone will agree that Surgery or Radiation and Hormone therapy (ADT) are efficacious treatments for prostate cancer (PCa).
Your comfort level with different types of treatments (radiation vs surgery) and their side effect profiles are the decision points (when you have a choice).
I chose surgery at age 72 because I wanted a chance for a "cure"; meaning to me, PCa not recurring for 10+ yrs. I know a few men who do not have rising PSAs 10 – 15 yrs following Prostatectomy.
Also, I am comfortable with a surgical procedure and recovery.
My procedure went very well. My recovery was excellent and with preop and postop Kegel PT, my continence has never been an issue.
Postop ED occurs, and mine may have been improving, but I failed my 90 day postop PSA (0.19), and went directly to salvage radiation and ADT, which put that element of recovery on pause.
I would choose surgery again, although some might view my story as a reason to have radiation.
However, I retained the option for radiation as a follow up treatment.
Also, my postop pathology Gleason scores were significantly different (9) than my preop interpretations (7).
And although my preop MRI indicated cancer contained within the prostate capsule, and I had clean margins, lymph nodes and seminal vesicles, Pathology indicated EPE.
Somewhat overwhelming amount of information.
Best wishes for a choice that gives you a good result.