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Diagnosed today w/ PCa. Seeking feedback w/ treatment I think I want

Posted by thig350 @thig350, Apr 10 8:13pm

Well, have been learning from this support group for past 5 months since PSA test came back 11.7 then 5 months later 8.7. Today, biopsy results were shared by my Urologist. Diagnosed with Grade 3 PCa. Data is as follows:

57 year old male.
Risk group: unfavorable intermediate risk prostate cancer
Prostate biopsy date: 4/2/26
Hypoechoic lesions: right base anterior
Clinical stage: T2a
Grade: 3
Highest gleason grade: 4+3
Cores positives on biopsy: 3/13
Prostate volume: 35ccs
Other imaging findings: MRI w PIRAD 5 lesion - right anterior transitional zone.

My urologist said that the two best treatment options were either remove the prostate or radiation with ADT. He recommends removal. Given my younger age, I really don't want to deal with ED or incontinence when I am in my prime if you will. I am leaning towards radiation with ADT. I believe it is called medical castration where they don't actually remove the testicles but instead provide meds to reduce the testosterone...

Urologist said that if I go with radiation I have a chance of down the road of bowel, rectum, bladder damage, urinary issues. Could be as much as 7-10 years away but the risk is there. Plus, no surgery if the cancer returns post radiation.

Can anyone here speak to life post radiation several years down the line? Is it that bad? If the cancer returns, am I limited with treatment options?

Also, what is it with the apparent milestones of 5 years post treatment and 10-15 years post treatment? Is this what the medical professionals are saying that prostate cancer survivors expected lifespan is post treatment?

I welcome any and all thoughts and feedback and thank you in advance.

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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clevelandguy | @clevelandguy | Aug 31 4:47pm

Hi brad72,
Sorry to hear about your radiation side effects hopefully your radiation issues will lessen over time. Based on your current state I feel it was the correct decision you made to stop the ADT drugs. I know that some of the ADT drugs are also taken with Prednisone which I took for another issue but could not tolerate due to sleep issues. If you are still interested after your ADT drugs wear off there are newer ADT drugs on the market in daily pill form with less severe side effects. Also if the ADT side effects return you can stop the daily pill. Good luck, hope you’re feeling better, quality of life does matter.
Dave 3+4

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txaiman | @txaiman | Sep 1 11:38am

DaVinci’d 2 1/2 years ago. Nodes removed at same time due to cancer just starting to break through capsule.
Multiple scans showed no metastasis but Doc thought 8 weeks of radiation would be wise due to genetics. Radiation was a breeze…slightly tired, urinary incontinence was negligible, maybe an occasional drop or two when I strained to get up from chair or bed…never even penetrated underwear to outside clothing.
Bowel incontinence was delayed and caught me by surprise while driving…not a good scene! But with a couple of months of time and knowledge about when it seemed worse (mornings) I now can control it.
Hormone treatment was the worst part of my experience. Super tired, upper body muscles turned to fat around my waist, genital shrinkage, ED, vertigo.
2 years, shot every 3 months, multiple PSA’s were .010
Now everything returned to pre hormone condition except ED and I go back for checkups every 6 months for 2 years, if still good, once a year for the rest of my life. Now 71…note: while I still have ED there are ‘workarounds’ that allow pleasure, similar to female
anatomy pleasure moves.

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lagnafinc | @lagnafinc | Sep 1 9:13pm
In reply to @lagnafinc "@jeffmarc Just a comment on "they didn't give you enough." In 2013 nobody was handing out..." + (show)
Profile picture for lagnafinc @lagnafinc

@jeffmarc Just a comment on "they didn't give you enough." In 2013 nobody was handing out 74Gy of radiation. Why? The machines were not accurate enough with tight enough margins to avoid burning up surrounding tissue. In 2013 for me it was was either 10 weeks with older, lessp-accurate non-SBRT technologies, brachytherapy, or the relatively unheard of high-dosage Cyberknife. New technology like proton therapy e.g. was only available in clinical trials, Trubeam was relatively new , and here in Idaho back then they were not doing high dosage Trubeam treatments for PC, only 10-[week low-dosage. Far as I know, they didn't even acquire their first Trubeam here in Idaho until 2015.

If I was diagnosed today, sure, there is a much broader range of technologies available which are every bit as accurate (sub-millimeter) as Cyberknife; and yes, today if I chose I could go through 28 days/fractions of SBRT and perhaps receive a total of 74GY @ roughly 2.6Gy per fraction. Would that have been better than what many of us did thirteen years ago? Since we cannot go back, I guess I"ll never know. But IMO 50Gy of Cyberknife over 5 days was as good as it got in 2013.

And by the way, biochemical recurrence does not mean a metastasis WITHIN the prostate tissue. "Metastasis" in any number of medical dictionaries is defined as the spread of malignant or cancer cells FROM an original, primary site (in this case the prostate) to OTHER parts of the body, with such movement typically occurring via the bloodstream or the lymphatic network. A simple example of that for PC would be a metastasis in the adjoining seminal vesicles from where bad things typically happen going forward.

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@lagnafinc Well, when I'm wrong I just try to admit it. I was examining the history of 70-78Gy dosages earlier than 2013. My problem is that my frame of reference for "high dosage" is Cyberknife, @10gy per day for a week (first time anyway..7.8 per day 2nd time). Because I never availed myself of longer-term low dosage treatments I never learned as much about them as I might have. So in point of fact you are very obviously right....70-78Gy treatments have been available for some 30 years now, just done over long periods of time, originally on 2D machines with wide margins; and because it's done over a longer period of time at say 2.8Gy per fraction, it's still commonly called "low dosage" no matter the total at the end. I got a documented lifetime dosage of 88Gy to my prostate over 10 days separated by eight years, and I have have no idea where I'd be had I chosen the other low dosage path. Might I have been able to avoid Cyberknife #2? Who knows...Like you said, you and I are both still here...all that matters.

Apologies...

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