Surgery or Radiation or Monitor: How do you choose?

Posted by whudup1 @whudup1, Dec 13, 2022

59 1/2 PC
Biopsy Results are positive
5 out of 12, Showed 3+3=6
1 out of 12 Showed 7
Surgery or Radiation or Monitor

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Welcome, @whudup1.
From your very brief message, I see you are 59 and half years old and have just received news that you have prostate cancer, with a Gleason score of 6 or 7. That must come as a shock.

Now you've been told that you can choose which treatment you would prefer – surgery, radiation or monitor, also called active surveillance. This is a decision that many men here have also faced. It seems almost impossible.

It sounds like you need more information to be able to an informed decision.

Do you know what stage your cancer is?
Have you discussed the possible side effects of each of the treatment options?
Do you know which side effect(s) you may be willing to accept? And which side effects you wish to avoid?

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I believe Stage 1,
Really don’t want to have ED, for the time being.
Guess it comes down to looking at long term picture, or just living Life out and enjoying every day even more.
Always been very healthy, No issues, don’t get sick much

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@whudup1

I believe Stage 1,
Really don’t want to have ED, for the time being.
Guess it comes down to looking at long term picture, or just living Life out and enjoying every day even more.
Always been very healthy, No issues, don’t get sick much

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Are you getting an MRI scheduled to better locate the cancer within the prostate?

For me the decision was based on potential need for more treatment which is more common than I had originally thought. I went with surgery simply because I was advised by many that it allows for radiation later if it's needed, and sure enough, that's what happened.
(surveillance wasn't an option for me, the cancer was a little more advanced than yours.)

I was told that if you get the radiation first, and the cancer survives and starts growing again, having the surgery is a much dicier issue than if you start with surgery and move to radiation if necessary.

The decision of course is a very personal one, this was just my thought process.
Best of Luck to you!

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You could consider actively monitoring…

It would help the forum members if you have your PSA history, any prior PSA tests and a current one that triggered the decision to do a biopsy.

See what your PSA does over time, if it continues to increase, you could use the data to determine PSADT and PSAV – https://www.mskcc.org/nomograms/prostate/psa_doubling_time…that may give you clinical data supporting continuing to actively monitor or treat. As a general guideline:

PSADT
> 12 months – no decision on treatment required, continue to actively monitor
>6 months but < 12 months – possibly, other clinical data such as imaging to inform a decision?
< 6 months – treatment decision needed.

Web 265 has a great suggestion, some type of imaging to try and determine where the PCa is. That could inform your decision if it shows anything outside the prostate.

With that clinical data you may not want to "rush" to any decision, rather, continue to actively monitor, have more PSA tests done, decide on if and when to get any subsequent biopsies, if so, not a TRUS but MRI guided.

Here's a link to a video which may help – https://www.urotoday.com/video-lectures/clinical-case-based-learning/video/mediaitem/2799-tumor-board-reviewing-the-use-of-psma-pet-in-the-care-of-patient-with-gleason-3-3-6-gg-1-prostate-adenocarcinoma-and-palb2-mutation-session-2-case-3-h-jacene-a-kibel-p-nguyen-a-morgans.html

Kevin

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I am currently 56 years old and was diagnosed with prostate cancer (Gleason Score 7 –> 4,3) in October, 2022. As with you, I am healthy and very active (wife says too active for my age 🙂 ). I did a significant amount of research (online, talking with doctors, talking with others that had PC or knew of those that had PC, etc.). My research showed that given my age and life expectancy (25+ years), the radical prostatectomy was the clear choice. Radiation is obviously less invasive, but decreases your options going forward (if you have recurrent PC) and opens you up to other issues over the long term. Our medical tools are good but not perfect – I just did not want to bet my life on doctors being able to track the cancer. Based on post-surgery pathology, my prostate cancer is thought to have been contained to the prostate (negative margins, seminal vesicles & 6 lymph nodes clear). However, I am a realist – This does not guarantee the cancer did not get out at some point, but does guarantee that the cancer cells that were in the prostate are now gone. Knowing this gives me a lot more confidence going forward.
As with everyone that has went through this decision, it is very personal and needs to align with your goals and expectations. For me, I am relatively "young" and wanted the identified cancer to be out of my body, with the lowest chance of recurrence.
Best of luck with your decision and please let me know if you would like any additional detail.

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@web265

Are you getting an MRI scheduled to better locate the cancer within the prostate?

For me the decision was based on potential need for more treatment which is more common than I had originally thought. I went with surgery simply because I was advised by many that it allows for radiation later if it's needed, and sure enough, that's what happened.
(surveillance wasn't an option for me, the cancer was a little more advanced than yours.)

I was told that if you get the radiation first, and the cancer survives and starts growing again, having the surgery is a much dicier issue than if you start with surgery and move to radiation if necessary.

The decision of course is a very personal one, this was just my thought process.
Best of Luck to you!

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That was exactly my thought process also. I was told my PCa has a 30% chance of recurrence in the next 15 years. I'm 60 yo and had RP robotically in August 2022. How long before you had the BCR? Thanks.

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It was quick, 7 mos!
07/20/21 PSA Result of 13.8
09/02/21 Radical Prostatectomy
10/22/21 PSA Result of <0.1 (not ultrasensitive)
01/26/22 PSA Result of 0.039
04/26/22 PSA Result of 0.091

Now using the common definition of BCR, I don't think I really ever got that far. From what I've read it's generally defined as =>0.2 in two subsequent blood tests. Given the numbers between Jan and April, my surgeon referred me right to the radiation oncologists in the hopes of getting in front of it.
Some might say it was premature, others would say it's an aggressive approach.

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@web265

Are you getting an MRI scheduled to better locate the cancer within the prostate?

For me the decision was based on potential need for more treatment which is more common than I had originally thought. I went with surgery simply because I was advised by many that it allows for radiation later if it's needed, and sure enough, that's what happened.
(surveillance wasn't an option for me, the cancer was a little more advanced than yours.)

I was told that if you get the radiation first, and the cancer survives and starts growing again, having the surgery is a much dicier issue than if you start with surgery and move to radiation if necessary.

The decision of course is a very personal one, this was just my thought process.
Best of Luck to you!

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In 2017 robotic aborted so went 2018 with 40 sets of radiation and Zolodex
In 2021 it metastases in L2 which I had radiated and back on Zolodex
Today My Bone scan and CT scan show small growths in T10, T11 and left hip socket with 1" x 1 1/2" of metastasis in L1 lumbar My L2 was radiated almost 2 years ago and put back on Zolodex injections every 3 months which will continue
In Jan medical oncologist medicating me with 3 daily pills of Enzalutamide oral chemo for life and they may use radiation on L1 and other spinal metastases
The say good probability of 5 years and maybe more I'm 78 Prayers so important
Ideas welcome

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